School-based Mental Health

School-based mental health and wellness initiatives are key to ensuring students are in school, healthy, ready to learn and prepared for success. Mental health includes both the absence of illness and the presence of high levels of wellbeing. Wellbeing includes having positive emotions, feeling fulfillment, contributing to the community and being able to cope with daily life stressors. Schools are a safe, accessible space for students to receive mental health services. School-based initiatives emphasize student and family voice and involvement through the processes.

Future Forward, Ohio prioritizes students through the investment of resources to support districts in meeting the mental health needs of their students and overcome obstacles to learning. This webpage provides resources for educators, administrators and school-based mental health professionals to strengthen school mental health to improve learning and promote success for Ohio’s students.  

For some students, mental health symptoms may first present at school. A student having trouble concentrating in class, being withdrawn, showing disruptive behavior or struggling to make friends may have mental health challenges. Mental health treatment in schools is effective in reducing mental health symptoms especially when treatment is integrated into the academic setting.

Mental Health Trends and Impact

In December 2021, the Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory noted a rise in certain mental health symptoms including depression, anxiety and suicidal ideation during the ten years leading up to the pandemic.

  • From 2009-2019, mental health challenges were the leading cause of disability and poor life outcomes in young people, with up to one-in-five children in the United States having a mental, emotional, developmental or behavioral disorder.
  • Between 2007 and 2018, suicide rates among youth ages 10-24 in the United States increased by 57%, becoming the second leading cause of death for individuals in that age range.
  • In Ohio, one-in-three students report challenges with anxiety.
  • The number of high-school aged kids with major depressive episodes has nearly doubled over the past decade.

For more information about trends and data in Ohio, visit:

School Mental Health

What is Comprehensive School Mental Health?

Comprehensive school mental health systems are built on a strong foundation of district and school professionals, including administrators and educators, specialized instructional support personnel (including school-based psychologists, social workers,  counselors,  nurses and other  health professionals), in strategic partnership with students, families and community health and behavioral health partners.

The National Center for School Mental Health recommends a comprehensive school mental health system of an array of supports and services that promote:

  • Positive school climate;
  • Social skills;
  • Mental health and well-being;
  • Support for students and staff;
  • Trauma-informed and restorative practices; and
  • Reduction in the prevalence and severity of mental illness.
Studies from The National Alliance on Mental Illness and the National Research Council have shown effective comprehensive school mental health systems contribute to improved student and school outcomes including:
  • Greater academic success;
  • Reduced absenteeism;
  • Decreased behavioral concerns;
  • Improved school climate; and
  • Improved academic outcomes.

Interconnected Systems Framework

The Interconnected Systems Framework (ISF) builds upon Positive Behavioral Interventions and Supports to include School Mental Health programs and services to promote prevention and intervention within multi-tiered systems of support (MTSS). The Interconnected Systems Framework is an emerging approach for building a single system to address mental health and social-emotional well-being in schools. The Interconnected Systems Framework uses MTSS core features to ensure mental health is embedded in all aspects of the learning environment.   

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Getting Started

What can schools and districts do?

Core components of a comprehensive school mental health system include well-trained school and district professionals, teaming and collaboration structures, resource mapping, tiered evidence-based practices, screening and referrals and use of data to inform decision-making.

SAP Model

SAP model of mental health intervention. The image below shows how Ohio’s Model SAP aligns with the Positive Behavioral Interventions and Supports pyramid. The SAP includes education, prevention, early identification, evidence-based interventions, referral, guided support, and case management. Universal (Tier 1) programming benefits all students, some of our students who are identified as at-risk benefit from Tier 2 programming, and those students who have been identified as having behavioral health and mental health challenges benefit from Tier 3 services.

Ohio Model Student Assistance Program

Part of the Ohio School Wellness Initiative, Ohio’s Model Student Assistance Program (SAP) is an evidence-based approach to support student and staff wellness. Ohio’s model is based on the Substance Abuse and Mental Health Services Administration’s (SAMHSA) guidance and aligned with Ohio schools’ existing structures such as the Positive Behavioral Interventions and Supports (PBIS) Framework.

The Student Assistance Program framework includes the following components: (1) awareness, (2) prevention, (3) early identification, (4) evidence-based intervention, (5) referral processes and (6) guided support services for K-12 students who exhibit a range of substance use, mental health and behavioral health risk factors that interfere with their educational success.

A strong SAP ensures that everyone’s voice is heard and relies on partnerships among schools, community partners, students, and families. Equally important is a solid focus on professional development and staff wellness, because staff who are well themselves are in a better position to support their students’ wellness. 

Ohio School Wellness Initiative

The Ohio School Wellness Initiative was a developed from a partnership between the Ohio Department of Education and Workforce, Ohio Department of Mental Health and Addiction Services and the Center for School Based-Mental Health Programs at Miami University aimed at providing prevention, early intervention, and support practices for K-12 students and developing staff wellness strategies within Ohio Schools. The initiative addressed the following three critical components to improve mental health and wellness.

The initiative created guidance and  resources for schools to:

  • Implement an Ohio Model of a Student Assistance Program (SAP) based on guidance from the Substance Abuse and Mental Health Services Administration’s (SAMHSA). Student Assistance Programming aligns with Ohio schools’ existing structures such as the Positive Behavioral Interventions and Supports (PBIS) Framework.
    • The SAP framework included the following components: (1) awareness, (2) prevention, (3) early identification, (4) evidence-based intervention, (5) referral processes, and (6) guided support services for K-12 students who exhibit a range of substance use, mental health and behavioral health risk factors that interfere with their educational success;
  • Strengthen Tier 2 (early intervention) and Tier 3 (individualized, intensive intervention) supports within the Ohio SAP model to address substance use, mental health and behavioral health concerns; and
  • Promote mental wellness among school administrators and staff.

For access to the Student Assistance Program and other resources, please visit the Ohio School Wellness Initiative webpage.

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School-Based Center of Excellence for Prevention and Early Intervention

The Ohio Department of Mental Health and Addiction Services, through Ohio Department of Education and Workforce federal emergency relief funding, awarded Miami University $5 million to prioritize mental health and wellness for K-12 students and staff across the state and create a School-Based Center of Excellence. The Center is a hub of current and ongoing school-based mental health initiatives, statewide projects and multiyear projects, including the Ohio School Wellness Initiative (OSWI), which includes best practice standards for student assistance programs and staff wellness frameworks.

Goals of the Center include:

  • Supporting the implementation and sustainability of Ohio School Wellness Initiative and Student Assistance Program;
  • Workforce development programming by providing training and support for aspiring and existing professionals;
  • Expansion of the Behavioral Health and Wellness Coordinator position to promote wellness systems for students and educators;
  • Identifying  areas that need further positive behavioral interventions and supports such as new anti-bullying lessons and campaigns;
  • Establishing more services for students who need extra support;
  • Conducting ongoing research and evaluation to identify the supports students receive and effectiveness of related outcomes.

Schools and districts can access support on prevention and early intervention information, resources and information about Behavioral Health and Wellness Coordinators from the Center. For technical assistance, information about the Student Assistance Program, staff wellness support or other questions about school-based prevention and intervention, contact:

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Planning and Implementation

Utilize Teams and Partnerships

Administrators, educators and school personnel can promote student mental health and address concerns. Collaborative partnerships guided by school staff help improve student outcomes. Schools and districts can identify a process to create referrals and link students with supports. The Student Assistance Program model includes how to align with other school initiatives and teams such as the Whole Child framework, multi-tiered systems of support, wraparound services, school-based health care, trauma-informed practices and the Ohio Improvement Process.

Partnerships between schools and community mental health professionals are crucial to promoting mental health in schools. Schools can foster partnerships by:

  • Developing a referral system to outside providers who provide services in their own sites;
  • Contracting or collaborating with providers from the community who provide school-based services onsite;
  • Identifying resources and strategies that align with needs;
  • Coordinate data collection or sharing; (Please note: LEAs must comply with the Family Educational Rights and Privacy Act (FERPA) when using student data)
  • Identifying areas of need or services gaps and assisting with removing barriers;
  • Providing professional development and content expertise.
Schools and districts can consider engaging with representation from partners such as county and local agencies (physical health, mental and behavioral health), prevention coalitions, Alcohol Drug Addiction and Mental Health Services (ADAMHS) Boards, Educational Services Centers (ESCs), state support teams, local health departments, Family and Children First Councils, juvenile court, the district liaison or educator supporting students involved in the justice system, homeless liaisons and local law enforcement.

Complete a Needs Assessment

Conducting a mental health and wellness needs assessment offers a process for identifying programmatic and systemic needs. To conduct a thorough needs assessment, district and school teams examine relevant data to understand the most pressing needs of students, schools and educators. The team can:

  1. Identify critical needs by using available data to inform decision making. This may include data from the district and school’s Positive Behavioral Interventions and Supports (PBIS) Team, discipline data, academic and attendance data, data from a school counselor, behavioral health and wellness coordinator, school nurse or school resource officer.
  2. Research and select strategies to address the root cause.
  3. Plan for implementation by developing SMART goals and action steps to implement solutions.
    • Map existing school programs, practices or initiatives to identify gaps in programming and practices to meet student and staff safety and well-being needs;
    • Identify school capacity to refer students to community-based behavioral health partners;
  4. Implement and monitor the action steps and impact on student outcomes.
    • Engage with local partners to fill gaps, supplement services and provide training to staff.
  5. Examine, reflect and adjust action steps based upon the effect on student outcomes.
    • Monitoring data about the provision and impact of supports for students can provide information about needs, gaps and patterns to guide decision making. Teams focusing on the implementation of the comprehensive mental health system can determine what data will be monitored, the frequency of collection and how the data will be shared with families and staff.
    • Suggested information to collect and monitor includes:
      • Referrals to tier II and III services within the school or outside partners;
      • Quantity and type of interventions provided;
      • Individual or school goals;
      • Student, family and teacher voice.

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Professional Development

School staff can learn more about skills, implementation strategies and current trends through trainings below:

  • Ohio Department of Education and Workforce Mental Health and Trauma Training Library: The library contains videos from Department-led conferences and webinars to support ongoing education on topics such as Trauma-sensitive Schools, Classroom Strategies for Supporting Students, School Wellness, Safety and more. The library currently highlights sessions from the 2022 Children’s Mental Health and Resiliency Conference led by Ohio’s schools and community partners to showcase best practices and partnerships. The Department will update the page as additional trainings become available. 
  • Mental Health Module Series: A series of interactive, self-paced learning modules on developing and implementing a Comprehensive School Mental Health Program at the community level and the state role in supporting Comprehensive School Mental Health Programs.
  • Advancing Comprehensive School Mental Health Systems: This resource synthesizes the knowledge and guidance of over 75 experts nationally to help guide local, state, and national efforts to strengthen school mental health efforts and to start to understand and bring consensus to the quality domains of school mental health. 
  • Mental Health Technology Transfer Center Network: Funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), the MHTTC Network includes 10 Regional Centers to support evidence-based resource development and dissemination, training and technical assistance, and workforce development for the mental health field.
  • Classroom WISE: Training to assist K-12 educators in supporting the mental health of students in the classroom and offers evidence-based strategies and skills to engage and support students experiencing adversity and distress.


Last Modified: 6/10/2024 3:27:16 PM