Ready, Set, Go, Review:
Screening for Behavioral Health
Risk in Schools
Acknowledgements
This report was prepared for the Substance Abuse and Mental Health Services Administration
(SAMHSA) under contract number HHSS2832017000751/HHSS28342001T with SAMHSA, U.S.
Department of Health and Human Services (HHS) in consultation with John Kelley, Ph.D. Nadine Benton
served as Contracting Officer Representative.
Disclaimer
The views, opinions, and content of this publication are those of the author and do not necessarily
reflect the views, opinions, or policies of SAMHSA or HHS. Nothing in this document constitutes a direct
or indirect endorsement by SAMHSA or HHS of any non-federal entity’s products, services, or policies,
and any reference to non-federal entity’s products, services, or policies should not be construed as such.
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Electronic Access
This publication may be downloaded at https://www.samhsa.gov/ebp-resource-center
.
Recommended Citation
Substance Abuse and Mental Health Services Administration: Ready, Set, Go, Review: Screening for
Behavioral Health Risk in Schools. Rockville, MD: Office of the Chief Medical Officer, Substance Abuse
and Mental Health Services Administration, 2019.
Originating Office
Office of the Chief Medical Officer, Substance Abuse and Mental Health Services Administration, 5600
Fishers Lane, Rockville, MD 20857. Published 2019.
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iii
Forward
“In 2003, the President’s New Freedom Commission on Mental Health concluded that
America’s mental health service delivery system was in shambles. The Commission’s
final report stated that “for too many Americans with mental illnesses, the mental health
services and supports they need remain fragmented, disconnected and often inadequate,
frustrating the opportunity for recovery.” A number of the recommendations of the
President’s New Freedom Commission on Mental Health were not implemented or have
only been partially realized. Since then, quality of life has not fundamentally changed for
adults with serious mental illnesses (SMI) and children and youth with serious emotional
disturbances (SED) and their families in the United States.”
-The Way Forward (2017)
Students are routinely screened for physical health issues (e.g., vision, hearing). However,
emotional or behavioral health issues are generally detected after they have already emerged. It
is time for that to change.
The Ready, Set, Go, Review: Screening for Behavioral Health Risk in Schools toolkit is designed
to guide schools through the process of developing comprehensive screening procedures, as well
as provide readily available resources to facilitate the implementation of effective behavioral
health screening in schools.
iv
Introduction
Fairhaven School District is a mid-sized suburban district. Students in Fairhaven are
generally high achieving, but they are not immune to typical challenges faced by many
students within their state and across the nation. The superintendent of schools, Dr.
May, is concerned with “educating the whole child” and recognizes the importance of
addressing educational factors which impact upon students’ success in school beyond the
traditional curriculum and academic influences. She wants to build upon students’
strengths and help them develop social and emotional “life skills,” while also identifying
students who present “risk factors” associated with adjustment difficulties that may be
related to behavioral or psychological problems. Dr. May recognizes that both these
factors (social and emotional skills and behavioral health risk factors) influence a
student’s performance in the classroom. While Fairhaven is like other school districts
which have limited fiscal and staff resources, Dr. May has prioritized these issues as part
of the District’s strategic plan. She has worked with families in the district to make this a
priority and has even used student “focus groups” to gain their perspective. However,
she is unsure of where to start or how to prepare the development of a comprehensive
plan that will help the district accomplish these goals.
Screening is a Component of a Comprehensive Systems Framework
School administrators like Dr. May often recognize the importance of addressing social and
emotional needs of students. In fact, a recent internal survey conducted by the School
Superintendents Association indicated that “students’ behavioral health needs” were the top
concern of superintendents across the country (K. Jackson, personal communication, June 25,
2018). Research conducted by The Collaborative for Academic, Social, and Emotional Learning
1
(CASEL) identified “social and emotional factors” as the most powerful influence over students’
achievement in school (CASEL, 2003). Students come to school each day with more than their
lunch and backpack. They bring life factors that shape their learning and development. These
influences range from family issues, health concerns, and culture of origin to behavior, learning
profiles, and abilities. Virtually all have the potential to impact the mental health of students.
Although historically mental health has been viewed through the lens of mental illness (e.g.,
depression, anxiety, etc.), society has come to recognize that good mental health is not simply
the absence of illness, but also the possession of skills necessary to cope with life’s challenges.
As education professionals, school staff need to understand the role mental health plays in the
school context because it is so central to our students’ social, emotional, and academic success.
Research estimates that one in five students will experience a significant mental health problem
during their school years. These issues vary in severity, but approximately 70% of those who
need treatment will not receive appropriate mental health services (Perou, et al., 2013). Failure to
address students’ mental health needs is linked to poor academic performance, behavior
problems, school violence, dropping out, substance abuse, special education referral, suicide, and
criminal activity (Darney, Reinke, Herman, Stormont, & Ialongo, 2013; Hawton, Saunders, &
O’Connor, 2012). These issues may seem foreign to elementary school, but mental health
concerns can develop as early as infancy, and, like other aspects of child development, the earlier
schools address them, the better.
Family is the first source of support for a child’s mental health. However, the increased stress
and demands of life today make it imperative that schools partner with families to help students
thrive. Indeed, schools are excellent places to promote good mental health. Students spend a
significant amount of time in school and educators can observe and address their needs. Doing so
2
effectively requires developing the capacity both to reinforce students’ natural mental health
strengths and to respond to students suffering from the more acute mental health disorders that
are on the rise today. However, school leaders often lack the information needed to implement
effective comprehensive school-wide behavioral health services.
Despite the lack of information for these comprehensive services, many school districts have
elements of a tiered system of support in place as part of their overall student support programs
(e.g., building level support teams, data-based decision making, school-wide bullying prevention
and interventions, positive behavioral interventions, counseling services, etc.). These elements
can serve as the basis for the development of a comprehensive Multi-Tiered Systems of Support
(MTSS) to address behavioral health needs of students. MTSS can serve as the framework to
provide universal programs to help all students develop critical social and emotional skills, as
well as provide school-wide approaches to teach appropriate behavioral skills and manage
problem behaviors. MTSS also includes the provision of “targeted” services for students
displaying the emergence of problematic behaviors and emotions, as well as “intensive” services
for students with chronic psychological issues or maladaptive behaviors. Effective elements of
MTSS include the use of student data to screen for “risk” or the potential development of social,
emotional, and behavioral problems. Data are also used to help make decisions on when students
may need additional supports beyond the universal interventions provided to all students, to
monitor the effectiveness of certain programs, as well as measure the progress of individual
students. To collect varying types of data, many schools are incorporating the use of “screening”
tools to gain access to information not apparent in typical behavioral data (e.g., office referrals,
attendance records, etc.).
3
School Support
Intensive School
Interventions With
Community Support
Targeted School Interventions
With Community Support
Early Identification of Students With
Mental Health and Behavioral Health
Concerns
School Based Prevention & Universal Interventions
-
Students with
Severe/Chronic Problems
At-Risk Students
All Students
Targeted School Interventions
with Community Support
Early Identification of Students with Mental
Health and Behavioral Health Concerns
School-Based Prevention & Universal Interventions
Intensive School
Interventions with
Community Support
Intensive Community
Interventions w/ School Support
The Continuum of School Mental Health Services
Adapted from “Communication Planning and Message Development: Promoting School-Based Mental Health
Services” in Communique, Vol. 35, No.1. National Association of School Psychologists, 2006.
The provision of these services does not occur in isolation. Many schools are using an
Interconnected Systems Framework (ISF) to integrate the supports and services provided in
multiple systems (e.g., positive behavioral supports, school mental health services, community
supports, etc.). An ISF strategically aligns the goals and processes of school initiatives. The
Technical Assistance Center on Positive Behavioral Interventions and Supports (PBIS) in
collaboration with other partners produced Advancing Education Effectiveness: Interconnecting
School Mental Health and School-Wide Positive Behavior Support (Barrett, Eber, & Weist,
2013), which describes the “proposed mechanism that can effectively link School Mental Health
(SMH) and PBIS in order to leverage the individual strengths of each of these processes and
produce enhanced teaching and learning environments through their strategic linkage” (p. V).
4
This monograph (https://www.pbis.org/common/cms/files/Current%20Topics/Final-
Monograph.pdf) is an excellent guide and resources for school districts interested in developing a
comprehensive behavioral health support system for students.
Screening in Schools is an Expanding Practice
School-wide universal screening for mental health issues is a practice that has become more
prevalent and is now recommended by The National Association of School Psychologists
(NASP, 2009), as well as the National Research Council and the Institute of Medicine, who built
upon criteria established by the World Health Organization (O’Connell, Boat, & Warner, 2009).
Universal screening for behavioral and mental health issues can help with early identification of
students who are at-risk or in need of intervention related to these concerns, as research suggests
that significantly more students require mental health or behavioral services than currently
receive them (NASP, 2009). Universal screening for these concerns, particularly when
implemented within a multi-tiered model of behavioral support, may help these students receive
earlier services than they otherwise would and may prevent the need for more intensive special
education or therapeutic services.
Definition of Screening
While schools engage in various types of “assessment,” screening students for possible
behavioral health adjustment difficulties is different than other types of testing conducted in
school. According to the University of Maryland Center for School Mental Health, “mental
health screening is the assessment of students to determine whether they may be at risk for a
mental health concern. Screening can be conducted using a systematic tool or process with an
5
entire population, such as a school’s student body, or a group of
students, such as a classroom or grade level(s)” (CSMH, 2018).
This type of assessment differs from other activities such as
psycho-educational evaluations for special education eligibility
determination, diagnostic assessment for identifying specific
psychiatric disorders (e.g., depression, anxiety, etc.), or risk for
violence assessment (e.g., threat assessment). All these
assessments have their value in schools, but screening tends to be
broad-based in nature by evaluating groups of students and is
designed to identify “risk factors” for adjustment difficulties.
The purpose of screening includes (CSMH, 2018):
• Identify students at risk for poor outcomes
• Identify students who may need monitoring or intervention
(e.g., targeted supports for emerging adjustment problems,
intensive supports for chronic behavioral issues)
• Inform decisions about needed services
• Identify personal strengths/wellness as well as risk factors/emotional distress
• Assess effectiveness of universal social/emotional/behavioral curriculum
Identification Is Not
Diagnosis
The goal in identifying students with
possible mental health or substance
use problems is to provide the
option for further assessment. Such
identification does not involve
reaching a diagnosis of a condition.
Only mental health or medical
professionals (as determined by
each state’s licensing laws) are
qualified to make a diagnosis.
Neither action signs nor screening
tools provide sufficient information
to reach a diagnosis.
Research-based Practices in Screening
The use of universal screening instruments to get information about student academic, emotional,
behavioral, or social needs is a valuable practice within school-wide multi-tiered systems of
support (Bruhn, Woods-Groves, Huddle, 2014; Eklund, Kilgus, von der Embse, Broadmore, &
6
Tanner, 2017; Oakes, Lane, & Ennis, 2016). Universal screening allows for the early
identification of students who may need additional behavior support, including those exhibiting
both externalizing and internalizing patterns of problem behavior (Eklund et al., 2017; Kilgus &
Eklund, 2016; Oakes et al., 2016). Rather than relying only on teacher nomination or
examination of existing school data (e.g., attendance, grades), which are both a reaction to
existing problem behavior and more likely to identify students with externalizing problem
behavior, systematic universal screening is a proactive practice, decreasing the likelihood that
schools will overlook a student in need of support or intervention (Bruhn et al., 2014). Universal
screening shifts the focus from a reactive, wait-to-fail model to a proactive system in which
needs are identified early and interventions are delivered efficiently to the level of need
demonstrated by the student (Dowdy et al., 2015).
Why Intervene Early?
The good news is that that schools can help mitigate the effects of mental illness and allow
individuals to live fulfilling, productive lives. Research demonstrates that students with good
mental health are more successful in school. Longitudinal studies provide strong evidence that
interventions that strengthen students’ social, emotional, and decision-making skills also
positively affect their academic achievement in terms of higher standardized test scores and
better grades (Fleming et al., 2005; Durlack, et al., 2011; Taylor et al., 2017). Half of those who
will develop mental health disorders show symptoms by age 14 (Kessler, et al., 2005). Therefore,
early identification of risk factors or signs of adjustment difficulties provide an opportunity to
intervene before problems develop into more significant and costly impairments. Unfortunately,
signs are often ignored and not met with supports for the child. When schools, families, or the
community do not act early to support students, consequences such as suicide, incarceration,
7
homelessness, and school drop-out can be the outcome (Darney, et al., 2013; Hawton, et al.,
2012).
Involving Families and Students in Developing a Screening Process
When schools make students’ behavioral health a priority and engage in screening as part of their
multi-tiered systems of support, it is vital to involve families and students from the initial
planning phases. Parents/guardians are partners in the education process and have primary
responsibility for the health and well-
being of their child. They can serve as
strong advocates from the community to
support this type of program. Families
“W
E NEED TO KNOW WHAT IT
’
S
FOR,
WHO WILL SEE IT,
AND WHAT
DIFFERENCE IT WILL MAKE
.”
Student Voice
are key to promoting a youth’s healthy
development. As with physical health
decisions, parents/guardians are the decision makers regarding their child’s care for any
identified mental health problems. They have valuable information about their child’s normal
feelings and behavior. Encouraging the involvement of parents/guardians before asking consent
to conduct a screening is a valuable approach. The positive involvement of parents/guardians
may include engaging them in the process of setting goals for an identification initiative and in
the selection of methods for identifying mental health problems.
Students will be the subjects of the screening process and can provide important feedback to
facilitate the effective implementation of screening tools and supportive interventions. Critical to
this work will be the process of relationship building between young people and adult partners.
Schools need to emphasize the importance of creating space for students to advise and support
decision making through the stages of development, implementation, and evaluation of screening
8
activities. Involving students in decisions that impact on them can benefit their emotional health
and wellbeing by helping them to feel part of the school and wider community and to have some
control over their lives. At an individual level, benefits include helping students to gain belief in
their own capabilities, including building their knowledge and skills to make healthy choices and
developing their independence. Collectively, students benefit through having opportunities to
influence decisions, to express their views and to develop strong social networks.
Steps to engaging parents/guardians and students will be discussed in later sections of this
toolkit.
9
Ready: Preparing Infrastructure for Screening in Schools
Dr. May recognizes that she needs to engage in preparation to “lay the groundwork” for
the Fairhaven Schools to develop a comprehensive behavioral health program, which
includes screening of students for mental health and substance use risk factors. While her
intentions are good, Dr. May realizes that an effective program will involve various
stakeholder groups in the district. She decides that she will start with her annual
strategic planning review, where she evaluates the progress on goals and develops new
goals based upon the needs of the district. Dr. May always involves other administrators,
teachers and other school staff, as well as parents/guardians and students in this process.
She determines that this will be a good opportunity to discuss her desire to develop a
comprehensive behavioral health program, with mental health screening as part of this
program.
Strategic Planning for Comprehensive Behavioral Health Supports
Strategic planning is the process of setting goals, deciding on actions to achieve those goals and
mobilizing the resources needed to take those actions. A strategic plan describes how goals will
be achieved using all available resources. School districts of all sizes use strategic planning to
achieve the broad goals of improving student outcomes and responding to changing
demographics while staying within the funding that they are provided or able to secure. Planning
for engaging in “screening” should be embedded within the districts’ strategic plan.
Unfortunately, many school districts engage in the development of this type of plan in an
inefficient, ineffective manner. They tend to engage in the “tell, then sell” method by developing
a plan, then trying to “sell” it to the community. Instead, many school districts have proactively
shifted their strategic planning process to genuinely include and involve parents/guardians and
10
other constituents. At the school district level, strategic planning requires community
engagement and support. Collaborative leaders in education know that without community
support and the insight that comes with community engagement their strategic plans are likely to
fail. It is important to gain insights and gauge community preferences as early as possible.
School districts that engage
early in the planning process
have a much greater chance of
building a successful and
community supported plan.
Prioritizing students’ mental
health, which includes the
promotion of emotional
wellness and support for
emotional challenges, needs to
be a critical component of a
district’s strategic plan.
“Screening” under IDEA
While similar in concept, universal behavioral health
screening presented in this toolkit is different than
“screening” under the Individuals with Disabilities Education
Act (IDEA).
Universal screening under IDEA is a method by which school
personnel determine which students are “at risk” for not
meeting grade level standards. Universal screening can be
accomplished by reviewing a student’s recent performance
on state or district tests or by administering an academic
screening to all students. The screening of a student by a
teacher or specialist to determine appropriate instructional
strategies for curriculum implementation is not considered to
be an evaluation for eligibility for special education and
related services.
IDEA also permits the screening of children under the age of
three who have been referred to programs to determine
whether they are suspected of having a disability.
The Sacramento City Unified
School District (SCUSD)
developed a document entitled
“Strategic Recommendations:
Creating Capacity for Mental Health Services for SCUSD Students”
(http://www.scusd.edu/sites/main/files/file-attachments/final_report_-
_creating_capacity_for_mh.pdf). This document serves as a model for community and
11
stakeholder engagement and the development of an actionable
strategic plan to address the mental and substance use needs of
students. The value of having an effective strategic plan is that it
guides the allocation of resources and decision making is
measured against actions/strategies that will address the goals
outlined in the plan. Communication and decisions regarding
mental health screening are guided by the plan.
Clarifying Screening Needs
Many schools currently collect data on students. These range
from office discipline referrals (ODRs), attendance data, and
grades/GPA to health visits to the school nurse and family
economic indicators. Analysis of the data can help to identify
“risk factors” or students may be demonstrating adjustment
difficulties or other challenges. Developing and employing an
Early Warning System (EWS) that identifies at-risk students
through the analysis of readily available and highly predictive
student academic and engagement data is critical. Utilizing data
systematically to identify at-risk students as early as possible will
allow for the application of more effective prevention and early
intervention services. Utilization of various data tools assist
schools in identifying at-risk students. The Early Warning System
(EWS) High School Tool
(http://www.earlywarningsystems.org/resources/early-warning-
Screening for
Emotional
Wellbeing
Some schools choose to engage in
“strength-based” screening or
screening for emotional well-being.
It is widely recognized that a
student’s emotional health and
well-being influences their cognitive
development and learning, as well
as their physical and social health
and their mental wellbeing in
adulthood. Mental well-being is not
simply the absence of mental illness
but is a broader indicator of social,
emotional and physical wellness.
There are three key purposes for
which schools and colleges might
wish to measure mental wellbeing:
• to provide a survey
snapshot of student mental
wellbeing to inform
planning
• to identify individual
students who might benefit
from early support
• to consider the impact of
early support and targeted
interventions
12
system-high-school-tool/) was developed by the National High School Center at the American
Institutes for Research to allow users to identify students showing early warning signs of risk for
dropping out of high school. The tool calculates research-based early warning indicators that are
predictive of whether students graduate or drop out of high school. A middle school version
(http://www.earlywarningsystems.org/resources/early-warning-system-middle-grades-tool/) is
also available. These tools are in the public domain and are free to use.
It is important for schools to analyze existing data before making the determination to engage in
additional screening of students. This prevents a duplication of data, expenditure of additional
resources and staff time, as well as unnecessary demands placed upon the student population.
However, despite their predictive validity, ODRs do not detect a full range of emotional and
behavioral problems. ODRs are more highly correlated with externalizing behavior problems
(e.g., disruptive behavior, attention problems) than with other behavioral and mental health
problems (e.g., concentration problems, depression, anxiety, adaptive skills; Walker, Cheney,
Stage, Blum, & Horner, 2005). The reliance on ODRs to identify at-risk students places the focus
primarily on students with externalizing behavior problems, passing over students at risk of
internalizing behavior concerns (Walker et al., 2005). Additional data points are often needed to
conduct more thorough school-wide identification of students in need.
The decision to engage in additional screening is often based upon the needs of the school. The
Behavioral Health Team (see section below on school based teams) can make this determination
based upon several factors. To determine the areas in need of screening, multiple methods can
be used, including stakeholder interviews, focus groups and/or reviews of existing data sources.
The initial data can be used to determine the areas of greatest need, and the subsequent screening
data can be used to clarify this need and eventually inform creation of a plan for intervention.
13
Developing the Screening Process and Procedures
As indicated in the Introduction, “screening” is part of a larger comprehensive behavioral health
supports with a Multi-Tiered System of Support (MTSS) Interconnected Systems Framework
(ISF). However, the process of “screening” is far more than simply choosing a tool to use and
administering the assessment to students. Careful planning and preparation is required. Issues
related to the following factors must be addressed;
• Obtaining district, staff and family buy-in
• Allocating resources (fiscal and staffing) to support the screening process
• Defining roles and responsibilities of all staff involved in the screening process
• Addressing ethical and legal/liability considerations (e.g., parental consent and student
assent; communication; confidentiality)
• Selection of the right standardized screener(s) for your school/district (contextual fit)
• Training and professional development regarding screening (administration, data
analyses, decision-making, intervention selection, and decision-rules)
• Developing/expanding your data systems
• Identifying and coordinating resources necessary to support students in need of additional
intervention
The Ohio Positive Behavioral and Interventions Support (PBIS) Network has produced “School-
Wide Universal Screening for Behavioral and Mental Health Issues: Implementation Guidance.”
14
This is an excellent guide for school districts which are developing a screening process. This
document is available in Appendix I.
School-based Behavioral Health Teams
As schools and districts plan for the incorporation of universal screening as part of their
comprehensive behavioral health support plan, it is important for teams to understand how to
plan for and make decisions from the data collected through the screening process. If a school
team whose purpose is to address student behavior or school climate issues does not already
exist, establishing or repurposing a leadership team is the first step in the process of
implementing school-wide screening for behavioral and mental health issues. It is recommended
that this team consist of leaders who will help plan, implement and evaluate the screening
process through collaboration and feedback with other school professionals, parents/guardians,
and any other indicated groups. This representative team should meet regularly to ensure that
screening efforts are planned for, implemented and monitored effectively.
Different schools may have different names for this team and may already have a team of this
nature in place that can subsume screening under its purview. If another team (e.g., Instructional
Support Team, Child Study Team, PBIS Team, etc.) adds this process to its agenda, it is
important that all members are aware of the importance of implementing this school-wide
screening before moving forward. The Center for School Mental Health (CSMH) at the
University of Maryland has developed the “School Mental Health Teaming Playbook: Best
Practices and Tips from the Field” (2018). The Playbook defines a behavioral health or “mental
health team” as “a group of school and community stakeholders that meet regularly and use data-
based decision making to support student mental health, including improving school climate,
15
promoting student and staff well-being, and addressing individual student strengths and needs”
(p.2).
Many schools have teams that meet to discuss and strategize about student mental health issues.
Schools may have one team devoted to the full continuum of mental health supports or multiple
teams that address different parts of the continuum. The CSMH Teaming Playbook
(http://csmh.umaryland.edu/media/SOM/Microsites/CSMH/docs/Reports/School-Mental-Health-
Teaming-Playbook.pdf) is an excellent resource for guiding schools on team development.
Selection of a Screening Tool
Selection of a screening tool should be based upon the areas of identified need of the individual
school or district. A wide variety of evidence-based screening instruments have been developed
and are available for use in the schools. Many of the tools are available at no cost to the school
district. However, while cost is a significant consideration, the primary considerations should be
whether the evidence-based instrument provide the appropriate information that the school
desires and whether the instrument is a good “contextual fit” for the school. The Ohio PBIS
Network (2016) has identified the following considerations to help schools select an appropriate
screening tool.
Population
• A screening instrument should always be chosen based on its relevance to the
school’s demographics and characteristics.
• Screeners must always be age- and developmentally appropriate.
• Ideally, a screener should have been validated or normed on a sample similar to
the population being evaluated.
16
• Many student and contextual factors (e.g., gender,
ethnicity, socioeconomic status, home language,
parent involvement) have been shown to affect cut
scores and overall prediction of risk status.
Feasibility and usability
• It must be practical to universally administer the
screener within the desired context, including clear
instructions and examples of any difficult concepts.
• The cost of the screener should not outweigh the
benefits obtained as a result of the process.
• Involved stakeholders (e.g., students,
parents/guardians, teachers and administrators)
should consider the screener to be acceptable and
useful.
What Is a
Screening Tool?
A screening tool is a brief list of
questions relating to a students’
behavior, thoughts, and feelings. It
usually takes only 5–15 minutes to
answer. A specific method is used
to score the answers to the
questions, and the score suggests
the degree to which the student
may have a problem. As with
medical tests, the language used
to refer to the results of screening
may be confusing. When a score
indicates a likely problem, it is
called a positive finding; when the
score indicates that a problem is
not likely, it is called a negative
finding. Like other medical tests,
sometimes screening tools might
miss problems or suggest a
problem when one may not exist.
Time
• Consider the amount of time to collect, score, enter,
manage and analyze screener data, in addition to administration time.
• Personnel time to train staff in the administration and completing the screening
process is an additional consideration that may be more important than the
physical cost of materials.
17
Psychometric evidence
• Reliability: the degree that the chosen screener results in similar scores each time
it is used.
• Validity: the degree that the chosen screener measures what it is supposed to
measure.
• Screeners should have valid cut scores, which help reduce false positives and
negatives and assure that students are receiving the services they need.
• False positives may be more desirable than false negatives with regard to
screening (e.g., it is better to catch too many students than too few).
Several compendiums of evidenced-based screening tools have been compiled by various
organizations. See Appendix III for a listing of these compendiums.
A number of jurisdictions have developed useful resources. For example, the Florida Project
Aware site developed a number of useful guiding questions for selecting a screening instrument.
18
Guiding Questions for Social-Emotional Screener Selection (Florida Project AWARE)
Goals and Objectives:
• What is the purpose of the social‐emotional screening process?
• What valued outcomes will be achieved?
• How will social‐emotional screening supplement existing Tier 1/screening data to inform decision making?
• How will a social‐emotional screener improve student access to a continuum of supports?
Technical Adequacy
1
:
• Norms: What type of sample was used to research the screener/develop norms?
• Reliability: Does the screener produce consistent results?
• Validity: Does the screener assess what it is intended to?
• How well does the screener predict future outcomes (problems and strengths)?
• Sensitivity/Specificity: Does the screener adequately capture true positives and true negatives?
• How many students does the screener misclassify (e.g., students truly at risk but identified as not being at risk [missed],
students truly not at risk but identified as being at risk [misidentify])?
Social Validity and Treatment Utility:
• Do students and family support the implementation of the screener?
• What valued outcome is the screener intended to inform?
• What questions about student mental health problems/risks and well‐being/protective factors can be addressed with the
screener?
• Does the screener align with preventive interventions/Tier 1 supports (e.g., inform intervention)?
• Does the screener predict future risk (e.g., identify students who may benefit from additional interventions)?
Usability and Practicality:
• Does the district/school have the necessary infrastructure to implement the screener?
• How much does the screener cost ‐‐ per manual, per student, per use?
• Manual or web‐based administration, scoring, reporting?
• Are multiple translations (e.g., English, Spanish) needed/available?
• Are there fiscal resources available to purchase and support the screener use over time?
• How many items does the screener contain and how long does it take to administer?
• Where and how will the data be securely stored ‐‐ via Excel sheets, district‐based data systems, or separate online
databases?
• How will data be used for decision‐making?
• What are the training and coaching needs to support effective implementation of the screening procedure?
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1. Professionals with training in statistics, quantitative methods, and measurement (e.g., psychologists) can provide valuable guidance on
the appropriate screening tool selection and its use for the intended student population and purpose.
Cultural and Linguistic Considerations
The Substance Abuse Mental Health Services Administration (SAMHSA) has developed
guidance on identifying mental health and substance use problems in students. Contained within
this guide are the following cultural and linguistic considerations when engaged in a screening
process (SAMHSA, 2011).
Are culturally and linguistically diverse populations being served?
Use of tools developed and tested primarily on an English-speaking population from the
mainstream culture introduces many important considerations related to the linguistic and
cultural appropriateness of the tool and interpretation of results. Schools should be aware that the
predictive effectiveness of available tools and their accuracy in screening cross-cultural
populations may not have been fully researched. Lack of research on the cultural appropriateness
of the tools requires special attention regarding how to make these tools meaningful for people of
different cultures and for those who speak diverse languages. Such attention is especially
important because of the significant variation across cultural beliefs and practices in what is
considered normal development and developmentally appropriate parenting. Variation may be
most significant for preschool and younger students.
What degree of literacy and fluency in English do the respondents have?
Some tools have translations, and some have been tested for a range of literacy levels. However,
even when translations are available, schools may need to determine if a tool effectively
communicates concepts to the specific population being served. Therefore, it is necessary to
determine whether the available translation is easily understood by the participating students,
parents/guardians, families, and other informants.
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What are the cultural beliefs and values of the service population regarding normal
development, mental health, and substance use?
Cultural differences in child-raising customs and in what is considered normal development may
show up as problems if the screening tool has not been normed for or informed by such
variations. The tool may be consistently misunderstood by the population being served, or it may
fail to distinguish the students with problems from those who are developing normally. Different
cultural groups should be consulted and asked to identify areas where misunderstandings may
occur. If necessary, another tool may be selected, or the existing tool may be modified by
rewording a question or weighting certain responses differently than prescribed.
Because changes to the screening tool or the interpretation of the results may affect the tool’s
validity, it is advisable to consult with the tool’s developers before making final changes. Tool
developers may have worked with other organizations on tool modifications, or they may have
recent research results that have not been published. At the very least, the developers can provide
insight into how the proposed changes may affect the screening results.
What are the limitations of using a screening tool that has not been fully tested with a particular
cultural group?
If a tool’s predictive effectiveness has not been fully researched for a school’s target population,
the school should keep in mind that the findings may not be as reliable or valid as the findings
for students from populations on which it has been normed and studied. Even when language is
not a concern, the school should select a tool that is seen to be acceptable, useful, and in
accordance with a specific community’s values and expectations regarding child raising or
mental health.
21
Few screening tools are designed for and tested on a variety of groups that differ culturally and
linguistically from the majority of the population. As a result, feedback from members of such
groups is needed to help assess whether proposed screening tools will be clearly understood and
to identify any screening items that will not be able to predict targeted problems in that culture.
The knowledge and understanding of cultural values acquired during this process must inform
the interpretation of screening results. The person administering the screens must be aware that
cultural differences in child rearing may result in very different interpretations of a student’s
behavior. Items that may be misinterpreted or that can carry a different meaning in a specific
culture should be given less weight, and the overall score should be considered less accurate.
Ideally, a school will work with its cross-cultural staff and representatives from the different
cultural groups it serves to identify such issues, select tools that minimize those issues, and help
other staff understand the nature of the cultural differences. Training to help staff members who
administer the screens to discuss potential cultural issues with the family also would be of value.
The following resources are available for a more detailed discussion of culturally and
linguistically appropriate screening tools that have been studied.
Communicating with Stakeholders Before Screening
Involvement of stakeholder groups prior to initiating screening is important to maximize the
effectiveness of the process. Schools may want to consider communicating with the following
groups to provide valuable information, as well as seek feedback and answer questions regarding
the screening.
22
Parents/Guardians and Students
Encouraging the involvement of parents/guardians before asking consent to conduct a screening
is a valuable approach. The positive involvement of parents/guardians may include engaging
them in the process of setting goals for a screening initiative and in the selection of methods for
identifying mental health problems. Explaining the purpose and intended use of screening tools
to students, in language they can understand, is also important.
What schools can do:
• Prepare the school and the broader community by providing information about mental
health, screening, and treatment. This approach may include educating residents about the
mental health problems that exist in the community and the resources that are needed to
address those problems.
• Address parental/guardian concerns regarding the impact of “screening” students (e.g.,
labeling and identifying students, stigma associated with risk factors).
• Involve families and community stakeholders in the planning of an early identification
initiative so their concerns are identified and addressed (e.g., conduct focus groups,
ensure that the planning team has parent/guardian and student members).
• Make special efforts to solicit the input and involvement of students and their families as
well as the input of different cultural groups in the local community to learn about their
beliefs and attitudes about mental health.
Screening tools generally focus on indications of problems. However, it is imperative that
schools use such tools thoughtfully in a strengths-based context. Partnering with a family
advocacy or youth advocacy organization can help in planning and implementing a family-
23
friendly or youth-friendly approach. Introducing the screening initiative can present an
opportunity to provide information about mental health problems and the value and nature of
intervention and treatment, which helps frame the discussion in a strengths-based context.
Involving students in decisions that impact them can benefit their emotional health and wellbeing
by helping them to feel part of the school and wider community and to have some control over
their lives. At an individual level, benefits include helping students to gain belief in their own
capabilities, including building their knowledge and skills to make healthy choices and
developing their independence. Collectively, students benefit from having opportunities to
influence decisions, to express their views and to develop strong social networks.
School Staff
Involving school staff in the development of a screening process and communicating the intent
and outcomes will facilitate “buy in” and cooperation. Teachers and other staff members often
provide critical input. Sharing information and communicating with staff in the following ways
may be helpful:
• Communicate screening process and procedures
• Provide professional development around implementation and data-based decision
making
• Share data and information:
o Graphs presented at staff meetings
o Progress of students and effectiveness of systems
o Screening procedures reviewed prior to each implementation
o Connecting outcome data to interventions for students
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Community Organizations/Agencies
Community providers augment the work of school staff and ensure access to the full continuum
of programs and services for all students. Partnering with community agencies allow schools to
maximize resources and options available to students and families.
Considerations for communicating with community partners include:
• Develop a memorandum of understanding/agreement of clearly defined roles and
responsibilities
• Provide professional development around implementation of screening process
• Share data and information regarding outcomes (upon parental consent)
• Communicate legal/ethical guidelines
Ethical and legal considerations
Before implementing any form of systematic screening, it is important to review any relevant
federal, state, local and district guidelines that may help determine the legality, ethics, and
typical policy of conducting universal screenings in schools. It is important to emphasize that the
screening described in this toolkit does not fulfill the legal requirements under IDEA. Schools
should reference IDEA regulations regarding “child find” requirements and permissible
“screening.” However, there is general guidance provided on many issues related to behavioral
health screening.
FERPA and HIPAA
The relationship between the Family Educational Rights and Privacy Act (FERPA) and the
Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, often
25
creates confusion on the part of school administrators, health care professionals, and others as to
how these two laws apply to records maintained on students. When schools engage in mental
health screening, knowing which laws apply and how they will impact the use and
communication of screening results is critical. The U.S. Department of Health and Human
Services and the U.S. Department of Education issued “Joint Guidance on the Application of the
Family Educational Rights and Privacy Act (FERPA) And the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) To Student Health Records”
(https://www2.ed.gov/policy/gen/guid/fpco/doc/ferpa-hipaa-guidance.pdf). This document seeks
to answer many questions that school officials and others have had about the intersection of these
federal laws.
In addition, SAMHSA funds the Center of Excellence for Protected Health Information which
develops and disseminates training, technical assistance, and educational resources for healthcare
practitioners, families, individuals, states, and communities on various privacy laws and
regulations as they relate to information about mental and substance use disorders. These include
the Health Insurance Portability and Accountability Act (HIPAA) and 42 CFR Part 2. The
intersection of these laws and regulations with other privacy laws such as the Family Education
Rights and Privacy Act (FERPA) are also addressed.
https://www.caiglobal.org/index.php?option=com_content&view=article&id=1149&Itemid=195
Protection of Pupil Rights Amendment
Schools also need to consider rights afforded under the Protection of Pupil Rights Amendment
(PPRA). PPRA affords parents/guardians of elementary and secondary students certain rights
26
3
regarding the conduct of surveys, collection and use of information for marketing purposes, and
certain physical exams. These include, but are not limited to, the right to:
• Consent before students are required to submit to a survey that concerns one or more of
the following protected areas (“protected information survey”) if the survey is funded in
whole or in part by a program of the U.S. Department of Education (ED)
1. Political affiliations or beliefs of the student or student’s parent;
2. Mental or psychological problems of the student or student’s family;
3. Sex behavior or attitudes;
4. Illegal, anti-social, self-incriminating, or demeaning behavior;
5. Critical appraisals of others with whom respondents have close family relationships;
6. Legally recognized privileged relationships, such as with lawyers, doctors, or
ministers;
7. Religious practices, affiliations, or beliefs of the student or student’s parent; or
8. Income, other than as required by law to determine program eligibility.
• Receive notice and an opportunity to opt a student out of -
1. Any other protected information survey, regardless of funding;
2. Any non-emergency, invasive physical exam or screening required as a condition of
attendance, administered by the school or its agent, and not necessary to protect the
immediate health and safety of a student, except for hearing, vision, or scoliosis
27
screenings, or any physical exam or screening permitted or required under State law;
and
3. Activities involving collection, disclosure, or use of personal information collected
from students for marketing or to sell or otherwise distribute the information to
others. (This does not apply to the collection, disclosure, or use of personal
information collected from students for the exclusive purpose of developing,
evaluating, or providing educational products or services for, or to, students or
educational institutions.)
• Inspect, upon request and before administration or use -
1. Protected information surveys of students and surveys created by a third party;
2. Instruments used to collect personal information from students for any of the above
marketing, sales, or other distribution purposes; and
3. Instructional material used as part of the educational curriculum.
These rights transfer from the parents/guardians to a student who is 18 years old or an
emancipated minor under State law. A template for PPRA notification to parents/guardians is in
Appendix I.
Obtaining Informed Parental Consent
A school must have in place clearly written procedures that comply with a state’s legal
requirements for requesting consent and notifying legal guardians or students of the results of
screening activities. These procedures should identify specific circumstances in which the
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information will be shared with other service providers. Schools should consider the following
factors when implementing key steps of the screening process:
If the legal guardian is to be the informant, getting parental consent is straightforward.
The school needs to:
• Explain that the tool can help identify if the student has a social or emotional challenge;
• Inform the legal guardians that if such a challenge is identified, they will be assisted in
following up on the information;
• Explain confidentiality;
• Let parents/guardians know that they and their students are not required to complete the
tool or answer any question they find objectionable; and
• Encourage legal guardians to ask questions and express concerns about their student’s
social and emotional development.
If the legal guardian will not be present when the screening tool is administered, the school
needs to obtain written, informed consent from the legal guardian. Passive consent from
parents/guardians may be obtained, if there is a provision for the parent and/or student to “opt
out” of the screening. The following steps have been found to be helpful in answering legal
guardians’ questions and addressing their concerns:
• Provide information about the tool, the process, and follow-up assistance;
• Provide a contact name for someone who can answer questions; and
• Make a copy of the screening tool available to the legal guardians.
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It is recommended that organizations require active consent, which means that a student is not
screened unless the legal guardian has signed a consent form and returned it to the school.
However, properly executed passive consent procedures are appropriate. The Wisconsin
Department of Public Instruction has developed a “question and answer” document
(https://dpi.wi.gov/sites/default/files/imce/sped/pdf/rti-consent.pdf) that provides guidance on
obtaining consent for screening
Obtaining the Assent of Students
Although most minors cannot provide legal consent, schools should seek informed assent from a
student who is asked to complete a screen. Assent is the willing agreement to participate in an
activity for which the purpose and process has been explained and any alternatives have been
discussed. In addition to being the right thing to do, assent is a practical necessity when the
informant’s willingness to participate openly is critical to obtaining useful results. In many cases,
it may be advisable to document a student’s informed assent with a signed assent form. A student
who has communicated unwillingness to participate can refuse to participate even when his or
her legal guardians have given formal consent. Some schools find it useful to develop guiding
principles, such as those developed by the Early Identification Workgroup of the
Federal/National Partnership (FNP) for Transforming Child and Family Mental Health and
Substance Abuse Prevention and Treatment.
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Principles Guiding Screening for Early Identification of Mental Health Problems in Children and Adolescents
Developed by the Early Identification Workgroup of the Federal/National Partnership (FNP) for Transforming Child
and Family Mental Health and Substance Abuse Prevention and Treatment, December 18, 2006.
1. First, do no harm.
2. Obtain informed consent.
• Screening should be a voluntary process—except in emergency situations, which preclude obtaining consent
prior to screening. In these circumstances, consent should be obtained as soon as possible during or after
screening.
• Informed consent for screening a student should be obtained from parents, guardians, or the entity with legal
custody of the student. Informed assent from students should be obtained. Clear, written procedures for
requesting consent and notifying parents/guardians and students of the results of early identification activities
should be available.
3. Use a scientifically sound screening process.
• All screening instruments should be shown to be valid and reliable in identifying students in need of further
assessment.
• Screening must be developmentally, age, gender, and racially/ethnically/culturally appropriate for the student
to the greatest degree possible and use of results should be informed by potential limits to validity as indicated.
• Early identification procedures and approaches should respect and take into consideration the norms,
languages, and cultures of communities and families.
• Any person conducting screening and involved with the screening process should be qualified and
appropriately trained.
4. Safeguard the screening information and ensure its appropriate use.
• Screening identifies only the possibility of a problem and should never be used to make a diagnosis or to label
the student.
• Confidentiality must be appropriately ensured and limits to confidentiality must be clearly shared within the
scope of obtaining informed consent/assent (e.g., when immediate steps must be taken to protect life in an
emergency situation).
5. Link to assessment and treatment services.
• If problems are detected, screening must be followed by notifying parents, students, guardians, or the entity
with legal custody; explaining the results; and offering referral for an appropriate, in-depth assessment
conducted by trained personnel with linkages to appropriate services and supports.
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Options for Funding Behavioral Health Screening
Funding of screening programs are often incorporated within the larger comprehensive
behavioral health program within the school. Following are general best practices suggestions for
financing school-based behavioral health programs (National Center for School Mental Health,
2018):
• Create multiple and diverse funding and resources at each tier to support a full
continuum of services
• Maximize leveraging and sharing of funding and resources to attract an array of funding
partners
• Increase reliance on more permanent versus short-term funding
• Use best practice strategies to retain staff
• Use economies of scale to maximize efficiencies
• Utilize third party reimbursement mechanisms (e.g., Medicaid, CHIP, private insurance)
to support services
• Utilize evidence-based practices and programs (cost effectiveness; return on
investment)
• Evaluate and document outcomes, including the impact on academic and classroom
functioning
• Use outcome findings to inform school district, community partner (e.g. collaborating
systems) contributions, and state-level policy impacting funding and resource allocation.
Many schools support behavioral health and screening programs through the general operating
funds of the district. However, following are some suggestions for funding alternatives.
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1. Medicaid Early and Periodic Screening, Diagnostic, and Treatment
There is no service category in Medicaid entitled “school based services”, however, the
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides
comprehensive and preventive health care services for children under age 21 who are
enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive
appropriate preventive, dental, mental health, and developmental, and specialty services.
Periodic developmental and behavioral screening dur ing early childhood is essential to
identify possible delays in growth and development, when steps to address deficits can be
most effective. These screenings are required for children enrolled in Medicaid and are
also covered for children enrolled in CHIP. In order to bill Medicaid for EPSDT services,
the service must be coverable in the state plan, the child or adolescent must be a
Medicaid recipient and the service must be provided by a qualified provider who meets
provider screening requirements. For more information about EPSDT, go to
https://www.medicaid.gov/medicaid/benefits/epsdt/index.html.
2. Every Student Succeeds Act (ESSA) Title IV Part A: Student Support and Academic
Enhancement Grants (SSAEC)
SSAEC are flexible block grants and are allocated to states using the Title I finding
formula. Funds will be allocated to states using the Title I funding formula. States will
allocate funds to LEAs using the same formula. Specialized instructional support
personnel must be involved in the development of district plans and applications for these
funds.
33
Districts must use at least 20% of these funds on efforts to improve student mental and
behavioral health, school climate, or school safety, which could include:
• comprehensive school mental and behavioral health service delivery systems,
• trauma informed policies and practices,
• bullying and harassment prevention,
• social–emotional learning,
• improving school safety and school climate,
• mental health first aid training, and
• professional development activities
3. ESSA Full Service Community Schools
ESSA authorizes a competitive grant program to support school community partnerships
to address the academic, health, mental health, and other needs of the school and
community at large. Any district wishing to receive a full-service community schools
grant must specify how specialized instructional support personnel will be involved in the
partnership and service delivery model.
4. ESSA Project School Emergency Response to Violence (Project SERV)
Funds are available to strengthen violence prevention activities as part of the activities
designed to restore the equilibrium of a learning environment that was disrupted by a
violent or traumatic crisis at a school.
5. SAMHSA Project AWARE-SEA Grants
The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for
Mental Health Services (CMHS) accepts applications on an annual basis for Project
AWARE (Advancing Wellness and Resilience in Education) - State Education Agency
34
(SEA) grants (AWARE-SEA). The purpose of this program is to build or expand the
capacity of State Educational Agencies, in partnership with State Mental Health Agencies
(SMHAs) overseeing school-aged students and local education agencies (LEAS), to: (1)
increase awareness of mental health issues among school-aged students; (2) provide
training for school personnel and other adults who interact with school-aged students to
detect and respond to mental health issues; and (3) connect school-aged students, who
may have behavioral health issues (including serious emotional disturbance [SED] or
serious mental illness [SMI]), and their families to needed services.
The AWARE-SEA program supports the development and implementation of a
comprehensive plan of activities, services, and strategies to decrease youth violence and
support the healthy development of school-aged students.
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Set: Screening Implementation Planning
Dr. May has established the foundations for her comprehensive behavioral health
program. Through her involvement with various stakeholder groups, she has prioritized
students’ mental health supports within the district’s strategic plan and has established
an initial goal of “screening” specific grade levels to pilot the process. Dr. May has
established a Behavioral Health Team (BHT) which facilitates the overall behavioral
health supports for the district and will guide the implementation of the screening
process. Realizing that it will take time to “scale up” the screening process, the BHT has
recommended screening of students for mental health risk factors during the transition
years of grade 6 and grade 9. While the team has selected an evidenced-based screening
tool, several additional steps need to be established prior to engaging in screening.
Starting Slow and Small
As schools and districts plan for the incorporation of universal screening as part of their multi-
tiered system of support, it is important for teams to understand how to plan for and make
decisions from the data collected through the screening instrument. For districts and schools
considering adding a universal screening process to their system of support, starting “slow” or
“small” is often a prudent initial approach. This allows the school to test out procedures and gain
valuable feedback. Starting small provides opportunities to make critical changes to the
screening process before scaling up the program.
Examples of “starting slow” may include:
• Screening students during important “transition” grade levels (e.g., grade 6 and 9)
• Targeting specific classes across grade levels that already present risk factors
36
• Teacher referral for student screening
• Pilot screening with select teachers
• Program/Intervention Evaluation
Staff Preparation
Ideally, individuals involved with both the screening process
and outcomes should be included in the planning stage.
Schools should consider including the building leadership
team (principal, assistant principal, etc.), families, education
and mental health professionals, primary care providers,
representatives of community agencies and any other relevant
individuals (Weist et al., 2007). Planning should include who
will complete the screening tool (e.g., student,
parent/guardian, or teacher) in addition to when and where
the screening will occur, and consideration of issues related to consent, confidentiality, and “buy
in” from staff, parents/guardians, and students. It is important to consider the plan for sharing the
screening information with parents/guardians, as well as connecting the student to further
assessment and/or treatment.
Utilizing Existing
Opportunities to
Screen
Schools engage in “screening” of
students at different points in the
school year. Consider using one of
the following opportunities to infuse
behavioral health screening.
• Physical/vision/dental
screening
• Academic screening
• School climate survey
• Youth Risk Behavior survey
It is important for staff to access training to increase their knowledge of emotional wellbeing and
indicators of emotional adjustment problems to help them identify mental health difficulties in
their students. This includes being able to refer them to relevant support, either within the school
or services in the community. This type of professional development is universally important.
However, in the context of behavioral health screening, it is vital for staff to recognize and
understand the signs and symptoms of both internalizing and externalizing emotional problems.
37
As part of the behavioral health screening process, the behavioral health team (e.g., the school-
based team leading the screening process) needs to establish a data interpretation process,
training of school implementation teams on this process, as well as building capacity, expertise,
and fluency in the use of data to inform decision making (see Data-based Decision Making
section in the “Go” chapter).
Resource Mapping
For districts and schools considering adding a universal screening process to their system of
support, Missouri School-wide Positive Behavior Support has a planning tool available for teams
to use as a guide (MO SW-PBS Tier II, 2017).
As part of the process of assessing the school’s ability to respond to the screening data with the
adequate level of support, schools can estimate their projected capacity for intervention by
Total Student
Our Numbers
Our Numbers
Enrollment
80%
____________
10%
15%
1%
5%
At _____(School Name)______, the student population is ___________ students. Based on the expected
percentages in tiered intervention, ____________ students, or 80%, will use expected behaviors when the
school implements Tier I Universal practices with fidelity. Approximately _________ – _________ students, or
10-15%, may need additional support, or Tier II Intervention, to reliably perform expected behaviors. Finally, it
is possible that ________ –________ students, or 1-5%, may need the most intensive level of support, a Tier III
Behavior Intervention Plan, over the course of the school year.
(MO SW-PBS Tier II/Tier III workbook, 2017)
38
completing a simple projection table (MO SW-PBS, 2017). The goal is to have effective
universal supports in place to sufficiently support approximately 80% of the students and provide
the environment to support the success of students who require targeted or intensive support as
they learn and practice new skills.
It is important to have a complete understanding of available school and community resources.
Mapping services and resources that are available in the school and in the surrounding
community to address the mental health needs of students and families is part of the screening
process. A key goal of resource mapping is to ensure that all staff is aware of what resources are
available within the school and community. There is a need for clear systems of who can make
referrals, how referrals will be made, and a plan to follow-up to determine the success of the
referral. Resource mapping identifies school and community assets, providing more specific
details about the resources/services that are available within the school, neighborhoods, larger
community, and State. When resource mapping is done well, there is a systematic process that
can match available resources with student and family needs (Lever, et. al., 2014).
The University of Maryland Center for School Mental Health has published the “Resource
Mapping in Schools and School Districts: A Resource Guide”
(http://csmh.umaryland.edu/media/SOM/Microsites/CSMH/docs/Resources/Briefs/Resource-
Mapping-in-Schools-and-School-Districts10.14.14_2.pdf). This provides excellent guidance on
engaging in a resource mapping process for schools.
Referral Pathways
Schools frequently use school-employed mental health professionals (e.g., school psychologists,
social workers) or partner with mental health and substance abuse providers to ensure that
39
identified students have access to assessment and treatment. Sometimes these mental health
partners are integrated in the school setting through school-based mental health clinics or are in
the community setting. Organizations that serve students may be reluctant to screen for students
with mental health or substance use problems if they believe that appropriate assessment and
treatment are not available. When organizations anticipate an access-to-care problem, they
should explore the willingness of the local mental health and substance abuse treatment
community to support a planned identification initiative. Treatment providers are likely to
experience busy times of the year; as a result, providers may be more willing and able to
accommodate referrals from a screening program if the program is scheduled for a less busy time
of year.
The School Mental Health Referral Pathways (SMHRP) Toolkit
(https://knowledge.samhsa.gov/resources/school-mental-health-referral-pathways-toolkit) was
funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) to
help state and local education agencies and their partners develop effective systems to refer
youth to mental health service providers and related supports. The SMHRP Toolkit provides
best-practice guidance and practical tools and strategies to improve coordination and
collaboration, both within schools and between schools and other youth-serving agencies. The
SMHRP Toolkit supports the cultivation of systems that improve the well-being of young people
by providing targeted mental health supports at the earliest sign that a need is present. The
SMHRP Toolkit delves deeply into the topic of referral pathways, which are defined as the
series of actions or steps taken after identifying a student with a potential mental and/or
substance use issue. Referral pathways vary from community to community based on cultural
and linguistic considerations and the resources available, including the public and private
40
organizations providing services to school-aged students. School and community-based mental
and substance use providers must understand their local community to ensure the seamless
provision of supports to students and their families. While referral pathways may involve
different partners, depending on the community, all effective referral pathways share similar
characteristics:
• They define the roles and responsibilities of all partners in a system.
• They have clearly articulated procedures for managing referrals within and between
partners.
• They share information efficiently across partners.
• They monitor the effectiveness of the evidence-based interventions provided by all
partners within a system.
• They make intervention decisions collaboratively based on what is best for young people
and their families.
The SMHRP Toolkit provides sample memorandums of understanding (MOUs) between school
districts and community providers.
The School-based Mental Health Model adopted by the Arkansas Department of Education
(http://www.arkansased.gov/public/userfiles/Learning_Services/School_Health_Services/SBMH
_Manual_June2012.pdf) is based on a strong foundation of collaboration and cooperation
between mental health providers and school districts. Partners share information readily and
easily, having established mechanisms to support this prior to implementation of the program
through an interagency agreement and/or business associate agreement.
Potential clinical partners include:
41
1. Private practitioners
Health professionals who are willing to support the early identification process and accept
referrals to assess students with positive screens.
2. Local community mental health centers
In many states, community mental health centers receive state, county, and Medicaid funds to
serve children, adolescents, and adults with mental health problems. Some centers also may
participate as providers for private health care plans. These centers may be able to accept
referrals and generally have some funding to serve students without insurance coverage. They
also may be able to refer organizations to the major providers serving private health plans.
3. Public substance abuse clinics
Publicly supported substance abuse clinics often serve Medicaid-eligible and uninsured people.
Although services for teens may be limited, they do exist. A list of clinics in a state
may be found by contacting the state’s substance abuse and Medicaid agencies.
4. Local community health centers
Community health centers provide primary health care for individuals on Medicaid or for those
who are uninsured. Increasingly, such centers also provide mental health services or have
partnerships with providers who serve their primary care clients. The Health Resources and
Services Administration (HRSA) provides a “Find a Health Center” Web site
(http://findahealthcenter.hrsa.gov/) to locate community health centers in specific areas.
SAMHSA has developed the Behavioral Health Treatment Services Locator
(https://www.findtreatment.samhsa.gov/), a confidential and anonymous source of information
42
for persons seeking treatment facilities in the United States or U.S. Territories for mental and
substance use disorders.
5. Hospitals
Hospitals are often willing to collaborate on plans to improve health in their local communities.
If hospitals offer psychiatric outpatient services or have affiliated mental health programs, they
are likely to participate in the provider networks of many health plans and can be a source of care
for students who are members of those health plans. Some hospitals also may accept Medicaid or
have funds to provide free care for uninsured students.
6. Non-clinical partners
It is important for schools to consider other potential partners beyond clinical referrals. Students
and families will often need and consider “non-clinical” supports before accepting therapeutic
interventions.
Additional Non-Clinical Community Partners and Supports
Peer support
Families and students may prefer peer-based services, either as a primary source of treatment, or in addition to
engaging in more formal behavioral health treatment services. Consequently, family and student support
groups play a valuable role in helping families negotiate service systems, educate themselves about their child’s
condition, or cope with the demands of a child with special needs. Schools should seek to partner with or offer
referrals to family and student support organizations operating within their state.
Faith communities
Communities of faith can be important partners by providing prevention activities and
support to their members and the broader community. Many families and students are more likely to seek
assistance and support from Faith leaders than from clinical providers.
43
Go: Engaging in Screening
The Fairhaven School District Behavioral Health Team has prepared the school staff in
grades 6 and 9 for the screening process. They are using an online screening tool, so
student data will be immediately collected, scored, and stored for reference. The teachers
have been provided a script to read to students to ensure uniformity of instructions and
implementation. Parents/guardians and students have received numerous
communications regarding the purpose, nature, and use of the screening. Fairhaven has
stressed to the parents/guardians that the screening is not intended to “diagnose”
students, but simply identify risk factors that may interfere with their ability to learn in
school and thrive in life. Alternative activities have been established for students whose
parents/guardians “opted out” of the screening. The Behavioral Health Team is
scheduled to review the screening results to vet the list of “at risk” students, as well as
identify students who need immediate follow-up due to their responses to critical items on
the screening. Both in school and community resources have been identified through
their resource mapping. They are set to GO!
Best Practices in Screening Procedures
Prior to administering the screening, staff education about the instrument and how it is
implemented leads to more reliable results. While this will vary based upon instrument and
context, it is suggested the following be provided to staff: a rationale for the process (the why);
an overview of the instrument, including operationally defining each of the questions asked (the
what); and how the results from the process will be used (the how).
Following are best practice considerations for implementation of screening tools:
• Every school should identify a site-based professional responsible for leading the
screening process, who will be available and accessible to address any potential issues
that may arise (Weist et al., 2007).
• If using technology to administer or compile screening information, it is wise to identify
a district technology specialist available to help with technology issues (Lane, 2015).
44
• Alternative activities should be provided for any students who are not participating in the
screening process (Weist et al., 2007).
• A “back to school” event for parents/guardians may be a natural time to address any
questions or have them complete the screening (Eklund & Kilgus, 2015).
• Privacy of respondents when answering is of utmost importance and may have an impact
on informant responses and validity (Fan et al., 2006).
• Providing proctors (e.g., teachers, research assistants, and school staff) with a specific
script to read can help standardize the administration across classrooms and create
increased efficiency and ease of use (Dever et al., 2012).
• Staff members proctoring the screening tool should be observant throughout the process
and prepared to intervene and refer to an appropriate staff member if a student displays
any unintended emotional response (e.g., agitation, crying, anxiety, etc.) (Weist et al.,
2007). Be aware that there is a potential for an item to trigger a negative response if it is
associated with prior trauma. Mental health support staff should be available for any
student who may be experiencing a negative reaction to the screening process.
The Student Voice
When schools engage in screening, there are several factors to consider from the “student’s
perspective.” It is important to introduce the measures to students properly so that they
understand why they are being asked to complete it and feel comfortable to answer the questions
openly and honestly. Students indicate that the following considerations are important.
1. The emotional experience of completing screening measures
45
It is often thought that screening measures that contain positively worded items have less
emotional impact on students. While this may make the experience of completing the
measure easier for students who are not experiencing difficulties, this may not be the case
for students who are experiencing difficulties. Answering positively worded items
negatively can be distressing or upsetting. For example, answering ‘no’ to questions such
as “I have an adult who cares for me,” “I feel loved,” or “I feel safe” can be difficult for
students. Sometimes negatively framed question can let a young person know they are
not the only person with difficult feelings.
2. Where will the measures be completed?
It is important to consider where students will be sitting when they are completing the
measures to ensure this will allow them to complete the measures privately. For example,
if students are sitting next to each other in a classroom, they may worry that others will
see their answers, and this will affect how honestly they complete the measure. Students
also report that it is important to make sure that they are not positioned in ways that
makes it seem like an exam or a test.
3. Students who need support to complete the measure
It is important to think about students who need support from an adult to complete the
measure, to enable them to answer openly and honestly. It is important to consider
whether the student can choose who supports them. Guidance for support staff to ensure
they understand confidentiality, know how to encourage the student to be honest and not
say things to please you. Let them know it’s ok to be honest.
4. Develop a script for introducing the measures and information for students
46
Students tell us that introducing the measures well is vital to make sure they understand
what they are being asked to do, why they are being asked to do it, and to make them feel
able to complete the measure honestly. Staff will have varying levels of understanding
about mental health, so consider developing a script or set of slides to ensure this is
consistent. It may also be useful to give this to students in an information sheet, so that
they can ask questions or know who to contact if they need support after completing the
measure.
5. Explain circumstances in which parents/guardians will be contacted based upon screening
results
Communicating Results to Students and Parents/Guardians
Communicating concerns about warning signs or positive screening results to parents/guardians
is imperative. Because parents/guardians must consent
to assessment and treatment of their child, and decide
how to follow up, they should be contacted promptly
by telephone or in person by the individuals trained to
discuss students’ mental health. Only the warning signs
and an explanation of what the screen can determine
should be discussed. Neither a diagnosis nor a specific
condition should be identified. In addition to informing
the parents/guardians at this time, a school should offer
resources for assessment as well as assistance in
making needed arrangements. The school should
47
provide details on follow-up assessment conducted by school personnel or by partner agencies in
the school or community.
Communicating with parents/guardians who speak languages other than English or who are part
of a different cultural group requires special skills. These skills may include speaking the
family’s language, using the services of an interpreter, and conveying information accurately
using language and terminology that is understood. A school should have procedures in place for
Communicating with Families: Tips for School
Professionals
(Project AWARE Ohio Brief No.5: August 2015)
1. Share concerns and test results with
parents/guardians in person.
2. Provide observations and concrete examples.
Avoid generalizations and labels.
3. Refrain from making judgments or
assumptions about the parents/guardians’
decisions regarding treatment or services.
4. Don’t assume you know how the
parent/guardian will react. Remember that
denial and anger may exist; relief and
validation may also exist.
5. Provide current and accessible information
about the student’s risk factors identified
through screening.
6. Provide information about local resources for
the student and information about parent
training and support groups.
7. Recognize the parents/guardians’ feelings
without displaying pity, shame or blame.
8. Be willing to participate in problem solving
and brainstorming.
9. Be open to ongoing communication and
support.
Communicating Positive Screen Results to
Adolescents
1. Meet with the student individually in a
private setting.
2. Reiterate the nature and intention of the
screening tool.
3. Discuss range of results of screening (no
risk, moderate risk, high risk) and
potential reasons why students may fall
in one category.
4. Explain the student’s individual screen
results in an open, honest, and direct
manner.
5. Reaffirm that screening is NOT a
diagnosis of mental illness, but an
indication of potential signs or risk
factors.
6. Explain follow-up procedures for further
assessment and supports.
48
prioritizing the notification of parents/guardians whose child’s warning signs or screens indicate
the existence of a high-risk or urgent situation. They should be called promptly to find out
whether they were able to schedule a timely appointment, whether they have any concerns about
getting care, and whether they need another referral. Families often encounter difficulties in
accessing mental health services. Schools should check back with families and help them address
any challenges they may have encountered or connect them with school-based services.
Data-based Decision Making
After universal screening, behavioral health teams are in possession of a comprehensive list
identifying the relative risk status of students in their population. If the school has chosen to use
an evidenced-based screening tool, “cut scores” or threshold points for level of risk will be
identified by the instrument. Screening results and potential actions will include:
• Positive for risk – need further assessment
• Some risk - monitor
• Negative for risk – nothing or multiple screening
However, it is important to engage in a few steps prior to taking any actions with students.
The first step in the intervention process is to review the validity of the list of students identified
by the screening to be at each level of potential risk. Vet the list with classroom teachers, student
assistance teams, leadership teams, a school psychologist, or school counselor and check for any
students whose screening results are surprises to school personnel. This can be an opportunity to
discuss why students may appear “under the radar” and who may be candidates for immediate
prevention programming versus a monitoring approach where teachers are notified of the
potential risk and are monitored by the Behavioral Health Team but are not asked to do anything
49
formal. There may be students for whom teachers feel are listed as “at risk” inaccurately.
Teachers may self-disclose that their ratings were skewed because of something in the classroom
or a personal conflict with the student. If students are self-rating, there may also have some
surprising results that warrant discussion. However, this feedback from teachers should not
substitute for a full exploration of factors potentially impacting upon students.
Checking the validity of screening results also provides information about the degree to which
teachers may perceive many students in an extreme way. In instances like these, it may be that
intervention is needed for the teacher and student or that additional support is needed for a
teacher’s classroom management skills, behavior management strategies, or perspectives on
appropriate grade- and age-level expectations.
After a list of screening results is vetted by a small group of professionals, those students
determined to meet the criteria for being “at-risk” need further assessment to determine the need
for supports and intervention. It is important to note that students with indicators for extreme risk
(e.g., threats to harm self or others, violence potential) need immediate assessment and
intervention. Engaging in “threat assessment” or violence potential is a different process than the
screening for risk factors associated with
adjustment problems in students. This
type of assessment needs to be
implemented by trained professionals.
Other students who present some risk
may be placed on a “monitor” list, which allows for a tracking of these students to watch for
changes in their risk potential. Students who present no risk do not need any immediate follow
up. However, all students should be included in any subsequent universal screenings.
STUDENTS WITH INDICATORS FOR
EXTREME RISK NEED IMMEDIATE
ASSESSMENT AND INTERVENTION
50
For those students with indicators for risk, Vannest (2011) has developed Targeted Intervention
Planning (TIP). TIP is an efficient process for quickly bringing prevention and intervention
services to students after universal screening. TIP involves problem identification, intervention
selection, teacher training, fidelity of implementation, and progress monitoring.
Problem identification
The first step post screening is problem identification. Once a student is determined to be “at
risk,” further assessment is conducted to determine the level of risk and intensity of intervention
needed. Some schools may contract with community providers to conduct follow-up assessment
and treatment after a positive screen. However, schools can also conduct school-based follow-up
assessment. Administration of broad-based behavioral assessments (e.g., BASC-2, Conners
CBRS) is one method to follow up on a positive risk screening. It is important to get additional
parental consent for this behavioral assessment. The results from a behavioral rating scale allow
schools to target and triage behavior and emotional problems for prevention and intervention.
Other options for further assessment of students with identified risk include parent/student
interviews to assess severity of risk factors and observations in the classroom.
Sample Notification to Parents/Guardians (Vannest, 2012)
Dear Parent or Guardian,
Our school district cares about the academic progress, health, and well-being of each of our
students. After our hearing, vision, behavior, and academic risk screenings this fall, results
indicate your student may be at risk in the area of:
____ Behavior and emotion
____ Hearing
____ Vision
____ Academics
51
_________________
To ensure that all students perform well in school, the school requests permission for
____Teacher rating of student behavior or performance (see attached consent form)
____ (List other options here)
If you have any questions or concerns about this information, please contact us at
Intervention selection
After identifying one or more problem area(s) to target, interventions best matched to address
those problems are selected. Interventions and supports are based upon the available resources in
the school and/or community (see Resource Mapping discussed in section 3-Ready:
Implementation Planning). Interventions are based upon the needs of the student, level of
severity, and availability and location of services. Dr. Olga Acosta Price (personal
communication, June 25, 2018), Director of the George Washington University Center for
Health and Health Care in Schools, indicates that no school system can handle ALL students’
mental health needs on its own and the need to think about partnerships to accomplish this work.
Typical responses by schools to students identified as “at-risk” include referral for services to
school-employed mental health professionals, partner mental health agencies co-located in the
school, or community professionals. These may include brief, time limited interventions or
longer-term therapy. However, it is also important to consider “non-clinical” type interventions
based upon the type of risk and needs of the students. “Non-clinical” interventions can include
mentoring either in school or in the community, connection to school or community activities
(e.g., sports, clubs, social activities, peer supports), and financial and/or legal services.
52
Directories of Evidenced-based Practices
• Promising Practices Network. http://www.promisingpractices.net/programs.asp
• CASEL: Collaborative for Academic, Social and Emotional Learning (SEL programs).
http://www.casel.org/programs/index.php
• CSPV: Prevention Research Center for the Promotion of Human Development at Penn State,
the Center for the Study and Prevention of Violence. http://prevention.psu.edu/
• USDOE: The United States Department of Education’s Exemplary and Promising Safe,
Disciplined, and Drug-Free Schools Programs 2001 (USDOE) (US).
http://www.ed.gov/admins/lead/safety/exemplary01/exemplary01.pdf
• CSMHA: Center for School Mental Health at the University of Maryland School of Medicine
(Recognized Evidence-based Programs Implemented by Expanded School Mental Health
Programs).
http://www.schoolmentalhealth.org/Resources/Clin/QAIRsrc/Summary%20of%20Recognized%2
0Evidence%20Based%20Programs6.14.08.doc
• Blueprints for Violence Prevention: Center for the Study and Prevention of Violence, University
of Colorado at Boulder. http://www.colorado.edu/cspv/blueprints/matrix.html
• OJJDP: Office of Juvenile Justice and Delinquency Prevention, US Department of Justice.
http://ojjdp.ncjrs.gov/programs/mpg.html
• Find Youth Info: Evidence-based Program Directory.
http://www.FindYouthInfo.gov/ProgramSearch.aspx
• The California Evidence-based Clearinghouse. http://www.cebc4cw.org/search/select
Teacher Training
Teachers and other staff are often important components of interventions selected to support
students at risk. However, implementation of interventions without appropriate preparation of
those who may be responsible for assisting with the support can lead to poor outcomes. Vannest
(2012) recommends “use of step-by-step directions with brief teacher training to build capacity.”
Teachers are more likely to support intervention use when outcomes are positive. Positive
outcomes occur most frequently when there is a close match between problem and treatment.
Therefore, using data to match interventions to problems and using evidenced-based
53
interventions are important. Building capacity to use prevention and intervention strategies
occurs over time, with support, leadership, and coaching.
Fidelity of Implementation
Implementation fidelity or “treatment integrity” refers to the degree to which an intervention or
program is delivered as intended. Whether an intervention to an at-risk student is provided within
the school or in the community, some type of fidelity check should be built into the process. This
can be accomplished by using evidenced-based programs which generally incorporate fidelity
checks into the program. However, all school staff members need to be properly trained to
ensure that the intervention is being implemented as intended. Schools can also build in fidelity
checks (e.g., implementation checklists, peer ratings of implementation, administrative
observation). Creating forms where adult peers can provide praise and feedback is a nice way to
make this a positive rather than a punitive experience. Also, when teachers see other teachers
executing plans and implementing strategies that are incorporated into academic instruction, they
are more likely to learn new practices, feel like the strategies are relevant, and maintain adoption.
Studies show that teachers distrust research and the longer they are in the field, the less likely
they are to rely on professional literature (Cook, Landrum, Tankersley, & Kauffman, 2003). Peer
modeling and support is important to ensure staff “buy-in.”
Progress monitoring
When students at risk have been identified, problems targeted, interventions selected, teachers
trained, and fidelity checked, then student response can be monitored. It is helpful to have
baseline data regarding student responses for the sake of comparison to screening later in the
school year. Progress monitoring is the frequent repeated measurement of a specific and clearly
54
defined behavior or construct (Parker, Vannest, Davis, & Clemens, 2010). Progress monitoring is
an essential component both for evaluation of student needs and response to individualized
interventions. Schools may want to consider utilizing a screening tool that can be used for the
initial screening of risk assessment, as well as a progress monitoring tool. For example, the
Boston Public Schools Comprehensive Behavior Health Model program
(http://cbhmboston.com/) uses the Behavior Intervention Monitoring Assessment System
(BIMAS-2) as an initial screener, and progress monitoring tool.
Selection of Interventions within a Multi-Tiered Systems of Support (MTSS) Framework
As discussed previously, screening is part of a school’s comprehensive behavioral health support
framework. Interventions and supports occur in a “tiered” manner based upon the needs of
students. MTSS involves the provision of preventive services to all students, targeted services for
students who display emerging problems, and intensive services for chronic or severe adjustment
issues. Screening of students is used to identify students at-risk for the development of
behavioral and/or emotional problems. Therefore, screening is generally part of a school’s Tier 2
services. It is a method to identify students who may need more intensive supports beyond those
provided to all students.
Screening results should guide the selection of the intervention. Tier 2 supports may be
appropriate for students who demonstrate risk factors that are emerging or indicate the potential
development of problems. Tier 3 interventions should be implemented for students who are
experiencing extreme risk factors or answer affirmatively on critical items (e.g., self-harm,
violence potential). However, schools may also use screening results to evaluate the
effectiveness of their Tier 1 universal supports. If screening results indicate the number of
students in need of Tier 2 or Tier 3 services beyond the expected ranges (Tier 2, approximately
55
15% of students; Tier 3, approximately 5% of students), this may be an indication of problems at
Tier 1. It is inefficient and unlikely to be sustainable for schools to serve 30-40% or more of their
students in Tier 2 and 3 interventions (Kilgus & Eklund, 2016). Schools can use information
from a screening instrument in the planning and provision of robust universal supports. The
school may use the information to incorporate social-emotional learning more prominently in
their school-wide efforts, engage in ongoing professional learning about positive mental health
and development, and focus their efforts more specifically to the areas of need indicated by the
data.
56
Review: Monitoring and Follow-up with Students
Fairhaven Schools have completed their initial screening of all students in grade 6 and
grade 9. Students who were identified as “at-risk” through the screening tool were vetted
by the Behavioral Health Team and those that needed further assessment or intervention
have been referred for the appropriate support. However, that does not end the screening
process. The Behavioral Health Team (BHT) has established a procedure to monitor the
students referred for additional supports, as well as students who presented some risk,
but did not need immediate interventions. The BHT has also established a screening
calendar to engage in progress monitoring of students identified as at-risk and additional
screening dates later in the school year.
Progress Monitoring of At-Risk Students
After students have been screened and appropriate interventions have been implemented, it is
important to engage in an ongoing evaluation process to determine the efficacy of the supports
and processes with regard to student outcomes. Developing a data base of students identified as
being at-risk, who either are receiving further assessment and intervention or who have been
designated to monitor, is an important tracking component. This data base can serve as a central
location to enter student data for easy monitoring. Schools that utilize Early Warning Systems, as
described in the “Ready” section of this toolkit, can develop a section for this student screening
data.
Progress monitoring is an essential component of any school program that has a screening
process in place. One of the important goals is not just to provide additional support, but to
provide support that makes a difference. The greater the support needs of a student, the greater
57
the risk for long-range problems. Therefore, increased attention to assessing the extent to which
support is being provided with fidelity and is effective is important. This information is then used
to maintain, modify or terminate support. Consistent with best practices for any intervention,
student progress should be measured to examine whether the intervention is effective for that
student. Progress monitoring of student outcomes should be based on a discrete and operationally
defined behavior or construct (Vannest, 2012). For behavior supports, progress monitoring of
office discipline referrals, student grades, attendance, daily progress points, or individualized
measures, may occur daily, weekly or monthly (May et al., 2012). If the data collected indicate
that student behavior is improving, and the identified need is being met, then the process has
served its purpose and the services and assessment should continue. Sometimes the selected
service or implementation does not adequately address the need and changes are required.
When the intervention is not having the desired effect, schools should evaluate the following
areas:
• Did the original assessment identify the problem correctly?
While screening is designed to identify the presence of risk factors, the integrity and
effectiveness of the follow up assessment is critical. If this assessment does not
appropriately identify the needs of the student and individual problems to address, then
the prescribed intervention(s) may prove ineffective.
• Is the intervention being delivered with fidelity?
Evidenced-based interventions are only as good as the manner in which they are
implemented. Implementation fidelity checks are an important part of the process. For
students receiving intervention from community providers, it is important for schools to
seek consent from parents/guardians to communicate to assess progress in treatment.
58
• Does the student need more intensive intervention?
Failure to respond to intervention may be an indicator of
the need to increase the level and intensity of intervention
provided. This should only be done after appropriate
problem identification has occurred, implementation
fidelity is ensured, and sufficient time has been given for
the initial intervention to be effective.
Options for Screening Frequency
Frequency will vary by screening instrument and school’s context
and purpose for screening. Screening instruments will provide
guidance with how that tool should be utilized. If no specific
guidance is provided, schools often engage in the screening
process at least two times throughout the school year. The first
administration take place approximately six weeks into the school
year. Some schools choose to complete a second administration
approximately four weeks after the start of second semester.
Practical application dictates that schools find a balance between
intensity/demands on staff and stakeholders to gather the data and
the overall usability of the results. It is important that each
administration results in schools/districts meaningfully utilizing
the data that is collected and fits within the overall student
monitoring system (e.g., early warning system).
Feedback on the
Screening Process
Effective screening programs in
schools will evaluate the screening
process to determine what worked
well and potential areas for
improvement or change.
• Fidelity data collected
during the screening
administration process
should be evaluated to
examine potential patterns
of low fidelity, which may
require future changes to
the universal screening
process.
• Any follow-up should
involve work with
implementers to address
any issues and help
reinforce the importance of
implementing the screener
as the school leadership
team designed.
• Feedback from anyone
involved with the screening
process (teachers, aides,
students, administrators,
etc.) should be considered
and reviewed by the
Behavioral Health Team to
improve the process in the
future.
59
Sample Data Entry Schedule
AUG
SEP
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
Student
Demographics
X
X
X
X
Report Card
X
X
X
X
Screening
Data
X
X
Discipline
Referrals
X
X
X
X
Attendance
Data
X
X
X
60
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Lane, K. L. (2015, October). A look at screening tools: From selection to implementation.
Session presented at the PBIS National Forum, Chicago, IL. Retrieved from
http://www.pbis.org/Common/Cms/files/Forum15_Presentations/B1_Lane-et-al.pdf
Lever, N., Castle, M., Cammack, N., Bohnenkamp, J., Stephan, S., Bernstein, L., Chang, P., Lee,
P, & Sharma, R. (2014). Resource Mapping in Schools and School Districts: A Resource Guide.
Baltimore, Maryland: Center for School Mental Health.
MO SW-PBS (2017). Tier II/Tier III team workbook. http://pbismissouri.org
National Association of School Psychologists. (2009). Appropriate Behavioral, Social, and
Emotional Supports to Meet the Needs of All Students (Position Statement). Bethesda, MD:
Author.
National Center for School Mental Health (2018). Funding Comprehensive School Mental
Health Systems. Presentation to the National Quality Initiative on School-based Health Services
(NQI-SHS) Collaborative Improvement and Innovation Network (CoIIN). Baltimore, MD.
Oakes, W.P., Lane, K.L., & Ennis, R.P. (2016) Systematic screening at the elementary level:
Considerations for exploring and installing universal behavior screening. Journal of Applied
School Psychology, 32(3), 214-233, DOI:10.1080/15377903.2016.1165325
O’Connell, M.E., Boat, T., & Warner, K.E. (Eds.). (2009). Preventing mental, emotional, and
behavioral disorders among young people: Progress and possibilities. Committee on the
Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young
Adults: Research Advances and Promising Interventions. Washington, DC: The National
Academies Press. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK32784/
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Parker, R. I., Vannest, K. J., Davis, J. L, & Clemens, N. (2010). Defensible progress monitoring
data for medium- and high-stakes decisions. Journal of Special Education, 46, 141–151.
doi:10.1177/0022466910376837
Substance Abuse and Mental Health Services Administration. (2011). Identifying mental health
and substance use problems of children and adolescents: A guide for child-serving organizations
(HHS Publication No. SMA 12-4670). Rockville, MD: Author
Taylor, R. D., Oberle, E. , Durlak, J. A. and Weissberg, R. P. (2017), Promoting Positive Youth
Development Through School‐Based Social and Emotional Learning Interventions: A Meta‐
Analysis of Follow‐Up Effects. Child Dev, 88: 1156-1171. doi:10.1111/cdev.12864
Vannest, K. J. (2012). Implementing interventions and progress monitoring subsequent to
universal screening. School Psychology Forum: Research in Practice, 6(4), 119-136.
Walker, B., Cheney, D., Stage, S., Blum, C., & Horner, R. H. (2005). Schoolwide screening and
positive behavior supports: Identifying and supporting students at risk for school failure. Journal
of Positive Behavior Interventions, 7, 194–204. doi:10.1177/10983007050070040101
Weist, M. D., Rubin, M., Moore, E., Adelsheim, S., & Wrobel, G. (2007). Mental health
screening in schools. Journal of Health, 77(2), 53-58.
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Appendices
Appendix I: Exemplars and Templates
Advancing Education Effectiveness: Interconnecting School Mental Health and School-Wide
Positive Behavior Support
https://www.pbis.org/common/cms/files/Current%20Topics/Final-Monograph.pdf
Early and Periodic Screening, Diagnostic, and Treatment
https://www.medicaid.gov/medicaid/benefits/epsdt/index.html
Missouri Schoolwide Positive Behavior Support Tier 2 Team Workbook
http://pbismissouri.org/tier-2-workbook-resources/
Model Notification of Rights Under the Protection of Pupil Rights Amendment (PPRA)
https://www2.ed.gov/policy/gen/guid/fpco/ppra/modelnotification.html
Ohio PBIS Network “School-Wide Universal Screening for Behavioral and Mental Health
Issues: Implementation Guidance.”
http://education.ohio.gov/getattachment/Topics/Other-Resources/School-Safety/Building-Better-
Learning-Environments/PBIS-Resources/Project-AWARE-Ohio/Project-AWARE-Ohio-
Statewide-Resources/Screening-Guidance-Document-Final.pdf.aspx
School Mental Health Referral Pathways (SMHRP) Toolkit
https://knowledge.samhsa.gov/resources/school-mental-health-referral-pathways-toolkit
School-based Mental Health Model adopted by the Arkansas Department of Education
http://www.arkansased.gov/public/userfiles/Learning_Services/School_Health_Services/SBMH_
Manual_June2012.pdf
Strategic Recommendations: Creating Capacity for Mental Health Services for SCUSD Students
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http://www.scusd.edu/sites/main/files/file-attachments/final_report_-
_creating_capacity_for_mh.pdf
The Early Warning System (EWS) High School Tool
http://www.earlywarningsystems.org/resources/early-warning-system-high-school-tool/
The Early Warning System (EWS) Middle School Tool
http://www.earlywarningsystems.org/resources/early-warning-system-middle-grades-tool/
University of Maryland Center for School Mental Health (CSMH) “School Mental Health
Teaming Playbook: Best Practices and Tips from the Field”
http://csmh.umaryland.edu/media/SOM/Microsites/CSMH/docs/Reports/School-Mental-Health-
Teaming-Playbook.pdf
University of Maryland Center for School Mental Health (CSMH) “SCHOOL MENTAL
HEALTH SCREENING PLAYBOOK”
http://csmh.umaryland.edu/media/SOM/Microsites/CSMH/docs/Reports/School-Mental-Health-
Screening-Playbook.pdf
University of Maryland Center for School Mental Health “Resource Mapping in Schools and
School Districts: A Resource Guide”
http://csmh.umaryland.edu/media/SOM/Microsites/CSMH/docs/Resources/Briefs/Resource-
Mapping-in-Schools-and-School-Districts10.14.14_2.pdf
The U.S. Department of Health and Human Services and the U.S. Department of Education
“Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA)
And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To Student Health
Records”
https://www2.ed.gov/policy/gen/guid/fpco/doc/ferpa-hipaa-guidance.pdf
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Appendix II: Promising Practices from States and School Districts
Following are examples of school districts or state level initiatives related to behavioral health
screening of students.
66
Pulaski County Schools
Pulaski County, Kentucky
Building a Model for Student Success
via an Integrated Systems Framework and Universal Screening
Research and support is emerging regarding the blending of school-based mental health care and school-
wide Positive Behavioral Interventions and Supports (PBIS) to improve student outcomes. This blending
of systems has become referred to as the Interconnected Systems Framework (ISF). ISF is an
implementation framework that creates and guides the linkage between education and mental health
systems to leverage and maximize the benefits of both systems of
care for students.
Pulaski County Schools have been a leader in Kentucky
with integrating educational and mental health systems
and have recently added a core foundational activity of universal
screening for behavioral health needs. Universal screening
expands the information available on a child beyond the existing
academic, attendance and discipline data and includes social and
emotional needs that may be getting in the way of student
success.
Screening data on all students can provide an indication
of an individual student’s performance and progress compared to the peer group’s performance and
progress. These data form the basis for an initial examination of individual and group patterns on specific
academic, social, and behavior skills. Universal screening is the least intrusive level of assessment
completed within Pulaski County Schools’ Response to Intervention (RTI) system and helps educators and
parents identify students early who might be “at-risk” for developing learning, behavior and/or social-
emotional challenges.
Beginning in the 2017-18 school year, Pulaski County Schools introduced the Student Risk Screening
Scale (SRSS-IE). This particular screener was chosen due to its ease of administration, low level of
intrusiveness and solid research base.
Key Milestones in the Creation of an Interconnected System
The timeline below documents key dates and activities related to the enhancement of Pulaski Public Schools’
approach to identifying and addressing the social and emotional needs of their students.
59
60
stance Abuse
*
Expanded Use of Mental Health Professionals to Address Need
The chart below documents the enhanced focus on mental health in recent years with an increase in the number
of community-employed, school-based mental health clinicians available to Pulaski County students.
YEAR 4
not available
until October
2018
Mental health professionals under
MOU with PCPS
Identification of AT-Risk Student
DATA E LEMENTS
Student Risk Screening Scale
(SRSS-IE),
3 times per year
Attendance
Grades
Office Discipline
* Family Resource and Youth Services Centers
*
61
With the addition of a process for screening all students for risks associated with their social and emotional
health, Pulaski County has another key source of information in determining a student’s need and deciding on a
strategy for addressing the need. Prior to implementing the process system wide, the SRSS-IE was piloted in an
elementary school, a middle school and a high school.
As seen in the data below from the 3 pilot schools, the Student Risk Screening Scale (SRSS-IE) measures
both internalizing behaviors and externalizing behaviors. While the students with externalizing behaviors
may have been identified through the office discipline data set, the SRSS-IE enhances the likelihood of
identifying students who might otherwise go unidentified such as a student whose response to trauma is to
withdraw rather than act out. Data in chart below highlight the value of a scale that screens for both.
Summary of Key Enhancements when PBIS becomes
an Integrated Systems Framework
1. Screening for social, emotional, and behavioral concerns; both internalizing and externalizing; allows
students to be identified early and linked to the appropriate intervention
2. Community partners, including parents and community mental health professionals, can provide an
expanded view of how students live and how they respond to their environment (school, community,
home).
3. Community partners who are familiar with operations of the school can enhance the school-based team
in ways that promote healthy social and emotional function for ALL students. Clinicians move from
being a separate and singular response to identified social and emotional needs to being social emotional
leaders within the school building.
4. Cross training with community employed and school employed mental health staff yields interventions
that are more consistently and competently delivered.
For more information:
Lori Price:
l
ori.price@pulaski.kyschools.us
Dusty Phelps: dusty.phelps@pulaski.kyschools.us
http://www.pulaski.net/for_staff/exceptional_children/rt_i__response_to_intervention/rti_for_behavior__pbis__and_mental
_health_supports
62
Welcome to the Boston Public Schools Comprehensive
Behavioral Health Model!
Picture a school in which children, families, faculty and community partners feel welcome and
valued. Every child experiences a pro-social curriculum as part of her classroom and school
experience. Teachers periodically review each of their students’ behavioral health strengths and
needs. Students in need of additional support are provided appropriate services in a timely
fashion. Teams of teachers and administrators review student behavioral health data and progress
on a regular basis. Community partners, families, and school personnel meet periodically and are
in consistent communication about children that are receiving additional support.
CBHM Lighthouse Model
63
Every Child Deserves a Safe and Supportive
School
CBHM promotes positive school climate and social and academic success for all
students. CBHM is a comprehensive model that integrates tiered supports and services within a
school according to student needs and recognizes family and community partnerships as an
integral part of a school’s success.
CBHM is currently in 40 Boston Public Schools. CBHM launched during the 2012-13 school
year in 10 BPS schools. Each year, another 10 schools join the model. Currently, 40 schools
have joined CBHM with more added every year! Each participating school has begun to
implement a tiered model of interventions and support, including a universal social emotional
learning curriculum and the CBHM screening tool, which helps schools better understand and
respond to each student’s behavioral health needs.
CBHM is Growing! Each school year a new cohort of 10–15 BPS schools will be added in
order to expand CBHM supports across the district.
Screening Tool
Creating safe and supportive learning environments that optimize academic outcomes for all
students includes identifying and responding to student needs with interventions and services.
The most effective way to identify these needs is through universal screening using a data-based
approach. As part of CBHM, universal screenings are conducted using the Behavior Intervention
and Monitoring Assessment System (BIMAS).
The BIMAS is a brief, repeatable measure of social, emotional and behavioral functioning in
children and adolescents ages 5-18. The BIMAS includes 34 items that are used for universal
screening and response to intervention. It was developed based on years of research and a
scientific model that identified items that are sensitive to change.
As part of CBHM, BIMAS serves three main objectives:
• Universal Screening: the small number of items on the BIMAS allows for classroom
teachers to rate her/his students quickly and effectively. The BIMAS can detect students
in need of further assessment and identify their respective areas of need.
• Student Monitoring: Students that are identified as being in need of additional supports
and services can have the effectiveness of their interventions monitored trough the
BIMAS system to provide feedback about the progress of the individual students or
groups in intervention programs.
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• Program Evaluation: The methods of data collection and analysis allow for reviews of
changes in a group of students receiving supports and interventions. This can help
determine the most effective interventions.
For more information about the Boston Public Schools CBHM program,
http://cbhmboston.com/.
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SCHOOL-BASED MENTAL HEALTH MANUAL
Arkansas Department of Education
The Arkansas Department of Education has fostered the development of approved best practice
school-based mental health programs within Arkansas public school districts. These programs
are grounded in and based on the following principles:
• An emphasis on early identification
• Full integration with the community and it’s resources
• Placing students and their families at the center of service decisions
• Providing services that are culturally competent
• A focus on promoting school attendance and academic success
• Services and supports validated by research and evidence-based practices
• The use of technology, including telecommunications
Access to a full array of mental health services is promoted at the school site within these
approved programs, always at no cost to students and their families. Best practice school-based
mental health services are characterized by the following:
• Student Supports
• Depending on the needs of students, an array of ―pullout interventions, including
evaluation, crisis services, diagnosis, individual, group, family therapy, case management
and day treatment
• Comprehensive intake, referral, and case management processes
• A collaborative partnership between school district and mental health provider staff
• Access to school-based mental health services without regard to student or family
Medicaid enrollment status and without cost to students and their families
• Appropriate linkages with community, regional, state and national resources
• Participation in Title XIX, Medicaid, either through provider enrollment or purchased
service contracts
• Maximum utilization of alternative funding streams, including third party payers, public
targeted and competitive grants, and private foundation funds.
Once approved, school-based mental health programs have access to these resources through the
Arkansas Department of Education:
• Auspices of working as an ―ADE Approved SBMH Program‖
• Technical Assistance, as needed
• Formalized best practices sharing among approved programs
• Current and topical evidenced-based research focused on Arkansas school-based mental
health data
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• Specialized training targeting Arkansas school-based mental health service delivery
issues and practice
For more information regarding the SCHOOL-BASED MENTAL HEALTH MANUAL
Arkansas Department of Education,
http://www.arkansased.gov/public/userfiles/Learning_Services/School_Health_Services/SBMH_
Manual_June2012.pdf.
67
Florida AWARE Model: The purpose of the Florida AWARE program is to build state capacity
to support districts in promoting mental wellness and ensuring that Florida youth who experience
mental health problems have timely access to effective and coordinated supports and services.
The program focus is on long-term systems change for integrating school and community-based
mental health supports within a multi-tiered service delivery framework based on a shared youth,
family, school, and community vision. At the state level, partners from multiple youth serving
systems and organizations serve on a State Management Team that provides oversight and
leadership. At the local level, three Florida AWARE districts (Duval, Pinellas, and Polk) are
developing and implementing a multi-tiered system of mental health supports that will serve as a
model for future scale up. Florida AWARE builds on the Florida Department of Education’s
successful implementation of multi-tiered models that focus on creating sustainable long-term
change based on prevention and implementation science.
Technical Assistance for LEAs: University of South Florida (USF) Florida AWARE project
staff provide the three Florida AWARE districts with ongoing technical assistance and coaching
support to build capacity for a comprehensive and sustainable multi-tiered system of supports for
complete mental health. For the specific focus on Universal Social Emotional Screening within a
MTSS, initial technical assistance provided to all three AWARE LEAs by USF AWARE staff
focused on two objectives for participating district teams:
• Increased knowledge and understanding of the value and function of universal screening
within a comprehensive multi-tiered system of social and emotional supports.
• Develop plans and procedures for implementing a universal social and emotional
screening system for informing evidence-based interventions, progress monitoring, and
evaluation.
Each district team received tools and ongoing technical assistance for initial selection and
implementation of an evidenced based, universal, social-emotional screening measure aligned
with district goals for improving student mental health outcomes. District goals were based on
information obtained by a comprehensive needs and resource assessment and guided by the
district’s vision for development of their implementation framework. District teams facilitated
the process of developing a system for implementing universal, social-emotional screening,
which involved working closely with the district legal representatives to address local, state and
federal policies. Strategies for securing and obtaining buy-in from key stakeholders, including
leadership, varied greatly amongst these three large districts. Duval and Pinellas County chose
to stagger their implementation by starting with one grade level per pilot school with the addition
of a grade level each year of implementation. After three years of screening implementation,
Duval has continuously built to a current level of full screening at two middle pilot schools and
three grades at four elementary pilot schools. Polk County initially started with implementation
focus on one pilot school with progression planned each year for adding pilot schools for full
screening and after three years of implementation is currently screening three elementary
schools. Pinellas is reexamining procedures to address barrier to implementation and is
considering selection of another universal, social-emotional screener as the measure the district
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had attempted to implement had high social validity but lacked alignment with program goals for
identification of students for early intervention that are at-risk for mental health problems.
Ongoing and Future Technical Assistance: Duval and Polk are currently focused on building
increased screening practices within their pilot schools and increasing capacity of district and
school teams to use social-emotional screening data with other outcomes measures, such as Early
Warning Indicators, for ongoing problem solving and tiered decision making. Duval County is
also starting to focus on districtwide scale up of the screening procedure they have developed.
For both of these districts, building capacity for effective and integrated databased decision-
making is an area of continuous improvement and future technical assistance for district and
school teams. Pinellas is currently reestablishing district buy in to overcome challenges of
changes in school leadership, lack of teacher buy in, low response rates during the pilot
implementation, and reevaluating instrument selection.
Lessons Learned/Reinforced For Success: A shared vision should drive development of a
comprehensive framework to meet the mental health needs of all students. This includes
leadership teams involving key stakeholders when making decisions about selection and
planning for implementation of social-emotional screening measures and careful consideration
for not only the validity of screening measures, but also contextual, cultural, ethical and legal
implications. Leadership teams should invest heavily in the planning and initial implementation
process to ensure that adoption of a universal social-emotional screening system results in
meaningful data that informs implementation and, ultimately, improves student outcomes, and,
in turn, increases buy-in for scale up. District and school-based leadership support and ongoing
technical assistance to schools developing their universal screening system is crucial to success.
Especially when there is clear plan for scaling up, starting small can be highly beneficial for
working out consensus on procedures such as consent, training and supports, and technology
challenges. Collaborating early with district legal counsel and IT has been a vital to successful
implementation. Developing a professional learning community with other districts
implementing universal social-emotional screening and seeking out ongoing technical assistance
have been critical to adoption. Universal social-emotional screening is a process that involves
commitment to continuous improvement as evidenced by all three Florida AWARE districts.
For additional information, access to our resources, please contact Natalie Romer
(romer@usf.edu) or Catherine Raulerson ([email protected]).
69
The Project About School Safety is a randomized controlled trial funded by the National
Institute of Justice (Award No. 2015-CK-BX-0018; 2016-2019, PI, M.Weist; Co-PI, J.Splett) to
test the effects of the Interconnected Systems Framework (ISF) on school safety in elementary
schools.
The ISF is a process and system for blending Positive Behavioral Interventions and Supports
(PBIS) and school mental health (SMH) to improve the depth and quality of interventions
delivered within a multi-tiered system of support (Barrett, Eber, & Weist, 2013). This process
includes integrating PBIS and SMH around three components of ISF, including teaming, data-
based decision making, and evidence-based practices. School-based teams for PBIS and multi-
tiered intervention service delivery are expanded to include mental health professionals and
mental health topics (e.g., school-wide social, emotional, and behavioral expectations; evidence-
based Tier 2 interventions for behavioral and mental health concerns). Universal mental health
screening is conducted to expand school teams’ data-based decision making. In addition, the
array of interventions delivered is expanded to meet the behavioral and mental health needs of all
students. Combined, the universal mental health screening and intervention array enable school
teams to identify and address early intervention and prevention opportunities for all behavioral
and mental health needs (Splett et al., 2018; Weist et al., 2018). Preliminary findings of the NIJ-
funded study are positive, documenting impact on improved team functioning, increased
identification and intervention services for students in need, particularly youth of color, and
improved students’ teacher-rated social, emotional, and behavioral (SEB) functioning.
Universal mental health screening was one component that schools randomized to the ISF
condition implemented during the Project About School Safety. Eight schools in two
southeastern school districts implemented the ISF. Schools implementing the ISF implemented
universal mental health screening via a team-led process with training and technical assistance to
support data-based decision making inclusive of the newly collected screening data.
Team-Based Implementation
Universal mental health screening was adopted and implemented in schools implementing ISF
via a multi-layered team approach. At the district level, a team of leaders from the school district
and community mental health agency worked together to guide implementation of the ISF and
universal mental health screening. The district-community leadership team provided decision-
making and guidance regarding the universal screening instrument selected, informed consent
procedures, implementation procedures and timelines, and professional development and
technical assistance offerings. With regards to informed consent, both school districts used
waiver of written consent or opt out procedures that aligned with procedures they use for
academic screening and intervention in their Response to Intervention model. Letters informing
parents of academic screening and intervention that were sent home at the beginning of the
school year were expanded to be inclusive of universal mental health screening and intervention
and copies provided to each school for distribution.
70
At the school level, existing leadership and intervention teams were expanded to include school
and community-based mental health professionals, consider universal mental health screening
data at all levels of service delivery, and access an enhanced array of interventions inclusive of
behavioral and mental health intervention practices. The school teams were led by building
administrators including principals, assistant principals, and/or student service managers with
responsibilities assigned to team leaders and members for agenda setting, meeting facilitation,
data review, note-taking, and time keeper. Teams were trained to use efficient teaming operating
procedures (e.g., defined roles and responsibilities, clear meeting purpose and agenda, action
plans reviewed and updated at beginning and end of meetings; Splett et al., 2017) such that
members’ satisfaction and engagement with team meetings would improve leading to improved
decision making and accountability between team meetings. Teams were also trained to evaluate
their team functioning, set action plans to improve, and evaluate progress regularly such that the
teaming process in which universal mental health screening was implemented was prioritized
and followed with fidelity. Preliminary findings indicate team functioning improved in ISF sites
and was significantly better than in schools randomized to control conditions not implementing
ISF.
Data-Based Decision Making
Once the universal screening data were collected, school teams followed guidance and training
provided by the project and district-community leadership team to (1) integrate results with other
existing school records data, including early warning indicators (e.g., attendance, discipline,
course grades), test scores and other measures of academic performance, (2) reviewing data at
multiple levels (e.g., school-wide, grade level, classrooms, gender and race/ethnicity), (3)
planning Tier 2 and 3 interventions following pre-determined data decision rules and
intervention protocol, and (4) monitor need for intervention in comparison to intervention receipt
at multiple levels (e.g., school-wide, grade-level, gender and race/ethnicity, and problem type) to
ensure students in need are getting intervention. More specifically, instructions were developed
and training provided such that school team leaders could integrate universal screening data with
other existing school records into one sortable spreadsheet. Instructions were also developed and
training provided to help school leaders and data review team members complete data review
procedures prior to team meetings, share results with team members, and facilitate data-based
decision-making discussions. Data decision rules and intervention implementation protocols
were developed by the district community leadership teams including data-based entry/exit
criteria, implementation procedures, fidelity monitoring, and progress monitoring for each
intervention available in the district’s expanded array of services. District leaders trained school
teams and mental health professionals in using this protocol to identify students in need of Tier 2
or 3 interventions, plan and implement the intervention, and monitor implementation and student
progress. Finally, progress of the team in using universal mental health screening data to
allocate intervention services was monitored by comparing need identified by the screener with
intervention receipt at multiple levels (e.g., school-wide, grade-level, gender and race/ethnicity,
and problem type). Team leaders and data review members were trained to track these data and
71
review findings in their team meetings 2-3 months after screening data were collected. When
needs were not being addressed at acceptable rates, teams engaged in data-based action planning
to examine why students in need were not receiving interventions at acceptable rates and
implement procedures to improve. Using these strategies, preliminary findings suggest the
proportion of students in need who received interventions in schools implementing ISF exceeded
the proportion achieved in schools randomized to control conditions and improved between each
subsequent year of study implementation.
References
Barrett, S., Eber, L., & Weist, M.D. (2013). Advancing education effectiveness: An
interconnected systems framework for Positive Behavioral Interventions and Supports (PBIS)
and school mental health. Center for Positive Behavioral Interventions and Supports (funded by
the Office of Special Education Programs, U.S. Department of Education). Eugene, Oregon,
University of Oregon Press.
Splett, J. W., Perales, K., Halliday-Boykins, C. A., Gilchrest, C. E., Gibson, N., & Weist, M. D.
(2017). Best practices for teaming and collaboration in the interconnected systems
framework. Journal of Applied School Psychology, 33(4), 347-368.
https://doi.org/10.1080/15377903.2017.1328625
Splett, J.W., Trainor, K., Raborn, A., Halliday-Boykins, C., Garzona, M., Dongo, M., & Weist,
M.D. (2018). Comparison of universal mental health screening and traditional school
identification methods for multi-tiered intervention planning. Behavioral Disorders, 43(3),344-
356.
Weist, M.D., Eber, L., Horner, R., Splett, J., Putnam, R., Barrett, S., Perales, K., Fairchild, A.J.,
and Hoover, S. (2018). Improving multi-tiered systems of support for students with
“internalizing” emotional/behavioral problems. Journal of Positive Behavior Interventions,
20(3),172-184.
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Appendix III: Research-based Screening Tool Compendiums
CSMH Comparative Review of Free Measures for School Mental Health
http://csmh.umaryland.edu/media/SOM/Microsites/CSMH/docs/Resources/Briefs/CSMH-
Comparative-Review-of-Free-Measures-for-School-Mental-Health.pdf
Ohio Project Aware Mental Health, Social, Emotional, and Behavioral Screening and Evaluation
Compendium (2nd Ed)
http://education.ohio.gov/getattachment/Topics/Other-Resources/School-Safety/Building-Better-
Learning-Environments/PBIS-Resources/Project-AWARE-Ohio/Project-AWARE-Ohio-
Statewide-Resources/Compendium-Version-2.pdf.aspx
SAMHSA Identifying Mental Health and Substance Use Problems of Children and Adolescents:
A Guide for Child-Serving Organizations
https://store.samhsa.gov/shin/content/SMA12-4700/SMA12-4700.pdf
73
Appendix IV: Technical Assistance and Mentoring Network
Susan Barrett
Director, Mid-Atlantic PBIS Network
Implementer Partner
Center on PBIS
www.pbis.org
443-377-2407
sbarrett@midatlanticpbis.org
Christina Borbely, PhD
Center for Applied Research Solutions
cborbely@cars-rp.org
707-929-4728
Mary Zortman Cohen, Ph.D.
Boston Public Schools
District MTSS Coach
781-975-0090
Katie Eklund, Ph.D.
Assistant Professor, School Psychology Program
Co-Director, Madison Education Partnership
University of Wisconsin-Madison
1025 W. Johnson Street
Madison, WI 53706
(608) 265-8091
Elizabeth "Betsy" Kindall, Ed.D.
School Based Mental Health Services Coordinator
Arkansas Department of Education
OUR Educational Cooperative
PO Box 610
Valley Springs, AR 72682
Office: 870.302.3094
Cell: 501.580.6827
Nancy A. Lever, PhD
Associate Professor
Co-Director - Center for School Mental Health
Executive Director - University of Maryland School Mental Health Program
74
443-506-6326
Olga Acosta Price, Ph.D.
Director, Center for Health and Health Care in Schools
Associate Professor, Milken Institute School of Public Health
The George Washington University
http://www.healthinschools.org
Joni Williams Splett, Ph.D.
Assistant Professor
School Psychology Program
University of Florida
(352) 273-4252
Kathryn Tillett, MSSW, CSW
Kentucky AWARE Project Director
Kentucky Department of Education
300 Sower Blvd, 5th Floor
Frankfort, KY 40601
(502) 564-4970
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