A novel mental health service-delivery framework: Integrating multi-tiered systems of support and community-based mentoring programs

Hart, M. J., Flitner, A. M., Kornbluh, M. E., Thompson, D. C., Davis, A. L., Lanza-Gregory, J., McQuillin, S. D., Gonzalez, J. E., & Strait, G. G. (2021). Combining MTSS and Community-Based Mentoring Programs. School Psychology Review.

Summarized by Ariel Ervin


Notes of Interest: 

  • Although American schools offer mental health services for youths, they are limited due to workforce shortages and available resources.
  • Because of these restrictions, they often lead to big caseloads and poorer-quality youth services.
  • This paper introduces a framework that combines multi-tiered systems of support (MTSS) and community-based mentoring programs to make evidence-based support more accessible to students.
  • This framework will make it easier for school districts and community-based mentor programs to collaborate and communicate.
  • Allows problem-solving teams to effectively use student data to pinpoint specific interventions and areas of need.
    • Community programs can then conduct evidence-based practices that address these needs.
  • Task-shifting several tasks from school psychologists to mentors will make it easier for practitioners to pay more attention to high-needs cases while providing supervision and consultations.
  • Task-shifting will also allow schools to provide more services.
  • Programs need to recruit mentors intentionally and thoughtfully if they want to take advantage of this framework’s benefits.
  • Effective communication and clearly defined roles among staff members can help 1) increase the quality of mentor supervision, 2) prevent burnouts, and 3) improve evidence-based interventions.
  • More research on task-shifting and preparing schools & mentors for this transition is needed.

Introduction (Reprinted from the Abstract)

In the United States, schools provide a large portion of child and adolescent mental health services; however, systems are restricted by resource and workforce shortages while the need for services steadily increases. This discrepancy leads to unmanageable caseloads for providers and reduced access to quality services for youth, and highlights a need to expand the school-based workforce to meet student needs. Herein, we propose a novel mental health service-delivery framework to offset these challenges by integrating mentors within the context of multitiered systems of support (MTSS) through task-shifting. We review and synthesize the literature in community and school psychology on the promises and challenges of youth mentoring and MTSS. We discuss the importance of diversifying school psychology, including the importance of increasing access to and benefit from educational supports for minoritized students, and the promise of mentoring within this context. We propose that by systematically integrating youth mentoring within MTSS there are several systems-level and individual-level benefits for youth, school staff, and mentoring nonprofits. We conclude by providing ethical, evaluation, and implementation considerations surrounding the proposed model.

Implications (Reprinted from the Discussion)

At present, there is a shortage of school psychologists and other mental health providers in the United States (Behavioral Health & Economics Network, 2018; NASP, 2017) and an increasing demand for services among children and adolescents. Among our rapidly changing cultural, social, and political contexts, and the current and emerging needs of youth during COVID-19, a restructuring of the field is needed to increase the acceptability and availability of mental health supports. In this paper we propose integrating mentors and MTSS frameworks to address this need, thereby leveraging community resources in efforts to holistically serve children (i.e., promote academic and emotional well-being) and advance the field of school psychology. Through our proposed model, students who otherwise may not receive access to school-based services benefit from having a mentor (i.e., experience an affirming relationship associated with flexible programming and positive developmental outcomes) and/or from receiving structured, targeted intervention support. Task-shifting select responsibilities from school psychologists to mentors also allows professional providers to exercise consultative and supervisory skills and to devote adequate attention to high-need cases, while at the same time expanding the overall reach of prevention and intervention services.

This approach reconceptualizes school psychology in a number of ways: First, school psychologists themselves can play a substantial role in this systems-level restructuring of school-based service provision. Given their backgrounds (i.e., expertise and training) and their positioning within school districts, school psychologists are well equipped to serve as architects of new infrastructure; however, they rarely get to exercise these skills in current MTSS designs. Moreover, this model proposes a novel partnership between schools and community-based mentoring programs with the goal of expanding the reach of school-based services for youth, which directly relates to school psychologists’ work. Although this approach shares similarities with others (e.g., community schools, in which schools and other community organizations overlap), it is distinct in capitalizing on an existing MTSS framework. This pragmatic decision (a) considers the current environment and its strengths, as well as areas for improvement in strategically planning future steps, and (b) allows for crucial attention to checks-and-balances and safeguards (e.g., supervision and training for direct service providers) in coordinating and integrating services.

We anticipate a number of benefits associated with the proposed model, which uses an ecological-systems lens and is cognizant of the current cultural and sociopolitical conditions. For example, we highlight the critical nature and value of aligning intervention content and delivery methods with the cultural values of those they serve (Banks & Obiakor, 2015). In addition to the existing advantages of employing mentors in this direct service work (e.g., high levels of community and participant acceptability, increased provider-and-student congruence, minimal associated stigma, and relative cost effectiveness), an important consideration for engaging in these efforts will be large-scale cultural responsiveness (e.g., cultural humility and racial justice) training across school communities. Incorporating these contextual factors into prevention and treatment holds power in increasing the effectiveness of intervention efforts. Furthermore, youth mentors’ favorable positions within communities fosters honest and important discussions to address potential disparities in access to care.

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