Using Behavioral Health Frameworks to Support Student Health

By Linda B. Sheriff, Deputy Director and Olga Acosta Price, Director at the Center for Health and Health Care in Schools  

As anticipated by many, schools are now facing an increase in social, emotional, and behavioral challenges. The traumatic events of the COVID-19 pandemic and the stress, grief, and loss it has caused can lead to numerous emotional and behavioral responses in students and staff, such as depressive symptoms and anxiety, difficulties with self-regulation, regression or loss of previously acquired skills and other academic or attention difficulties.

To support the health and well-being of everyone within the school community, many schools are adding mental and physical health services. But this is also an opportunity to review the school ecosystem and infrastructure and incorporate comprehensive behavioral health and social-emotional learning (SEL) frameworks throughout the school to provide more effective and sustainable supports for students, staff, and families. These are system level, organizing frames that can combine multiple programs and curriculums to enhance capacity and efficiency and improve outcomes. There are a number schoolwide frameworks to choose from including multi-tiered system of supports (MTSS), trauma-sensitive schools, the Whole School, Whole Community, Whole Child model (WSCC), restorative justice and more. Understanding their unique characteristics can be confusing and selecting one over the other can be difficult, especially when certain aspects of each are appealing. However, a basic knowledge of their elements and an awareness of where they are similar and where they differ offers the opportunity to integrate two or more.

To help guide this process, The Center for Health and Health Care in Schools at The Milken Institute School of Public Health at the George Washington University developed Effectively Integrating School Behavioral Health Frameworks to promote Student Success, a guide for educators and education leaders that provides an overview of the main components of some of the most prominent school behavioral health frameworks. It also describes their similarities and differences and ways to successfully integrate two or more of them. We defined a framework as an organizing structure that specifies the necessary elements and guiding principles necessary to reach a desired outcome. Furthermore, while we focused on frameworks that have a high-profile in District of Columbia (DC) Public Schools and Public Charter Schools, they are all being promoted nationally. The frameworks included in the guide are: Whole School, Whole Community, Whole Child (WSCC), Multi-Tiered System of Supports (MTSS), Response to Intervention (RTI), Positive Behavioral Interventions and Supports (PBIS), Restorative Justice, and Trauma-Sensitive Schools.

Each of these frameworks is designed to support student social, emotional and behavioral health and well-being, and ultimately their academic success. They provide a systems-oriented approach that encourages a school-wide focus on the coordination of programs, policies, and practices that advance healthy child and youth development. Each one also promotes a positive school climate, helps direct the actions of adults, and underscores the importance of teaching social and emotional skills. While each framework articulates a slightly different pathway to student social, emotional, and behavioral health, because of the overlap, they can be integrated and utilized simultaneously in a school. You don’t need to choose just one.

For example, WSCC provides an overarching frame for coordinating all health-related activities within the school eco-system, while MTSS, PBIS and RTI design or direct the infrastructure (think of it like rooms under the frame), within which restorative and trauma-sensitive practices (the furniture or fixtures in each room) allow students and staff to flourish.

To illustrate this, we spoke with a school leader in two DC schools that have successfully integrated multiple frameworks to support student health and well-being. We also asked them to describe the challenges they faced, how they overcame them, and any advice they had for other leaders looking to implement multiple approaches. As described in more detail in the guide, both schools use MTSS and RTI as their main structural frameworks and then integrate elements of other frameworks into the varying tiers of support. One of the schools also prioritizes areas that incorporate the local and school community and other WCSS dimensions into their plan. Furthermore, while they offer additional, practical suggestions, leaders at both schools emphasized the need to involve the school community in developing and implementing the initiative. They cautioned other leaders that the process takes time and not to expect immediate changes, but offered reassurance that the time spent led to sustainability and better outcomes.

As schools continue planning and strategizing for how to best protect the physical health and safety of students, families, staff and communities in the coming school year, we believe that it is essential to equally prioritize their emotional, behavioral and social health and well-being. By implementing strong, evidence-based behavioral health frameworks, schools will be better prepared to address the emotional and behavioral health needs of students. These preparations and practices will help to establish an environment wherein students are better prepared for learning, whether it happens in the school building or remotely.