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As multitiered systems of support (MTSS) for improving student emotional/behavioral (EB) functioning are being scaled up nationally (Horner et al., 2014), there is a critical need to define how these approaches meet the needs of students presenting internalizing EB problems such as depression, anxiety, and trauma-related concerns. Contributing to the improvement of MTSS is the systematic joining of positive behavioral interventions and supports (PBIS) and school mental health (SMH) services. A recently defined interconnected systems framework (ISF; Barrett, Eber, & Weist, 2013) provides explicit guidance on doing this work, and a national workgroup for ISF is exploring its implementation in sites around the country. The theme of improving prevention and intervention for youth with internalizing issues is a significant emphasis in this effort. However, many schools and collaborating partners from the mental health and other youth-serving systems struggle to develop multitiered programs for youth with internalizing challenges. The underlying tenets and approaches for addressing internalizing problem behavior differ from those that focus on improving more distinct externalizing behaviors such as noncompliance, disruptiveness, rule violation, aggression, attention problems, and acting out. The overall goal of this article is to build from important prior reviews (e.g., McIntosh, Ty, & Miller, 2014) and lessons being learned as the ISF is implemented in sites across the country to improve multitiered promotion/prevention, early intervention, and intervention for students presenting internalizing problems. Within MTSS efforts, school staff and community collaborators (as in the ISF) continue to struggle to implement programs for youth with internalizing problems. Objectives of this article are to review background factors limiting attention to internalizing issues within MTSS and to present recommendations for moving the field forward in improving practice, research, and policy on these issues, with particular attention paid to the ISF and its critical role in this agenda. There are three sections to the article.

School mental health (SMH) programs are gaining momentum and, when done well, are associated with improved academic and social-emotional outcomes. Professionals from several education and mental health disciplines have sound training and experiences needed to play a critical role in delivering quality SMH services. School psychologists, specifically, are in a key position to advance SMH programs and services. Studies have documented that school psychologists desire more prominent roles in the growth and improvement of SMH, and current practice models from national organizations encourage such enhanced involvement. This article identifies the roles of school psychologists across a three-tiered continuum of SMH practice and offers an analysis of current training and professional development opportunities aimed at such role enhancement. We provide a justification for the role of school psychologists in SMH, describe a framework for school psychologists in the SMH delivery system, discuss barriers to and enablers of this role for school psychologists, and conclude with recommendations for training and policy. C 2013 Wiley Periodicals, Inc.

Despite schools increasingly adopting multitiered systems of support (MTSS) for prevention and intervention of mental health concerns, many are slow to adopt universal mental health screening (UMHS), a core MTSS feature, due to concerns about their limited capacity to meet the needs of all identified. In this study, we examined differences in the number and characteristics of students who would be identified for intervention services when UMHS in an MTSS were added to those students already receiving social, emotional, and behavioral supports. In a sample of 3,744 students in Grades 1 to 5 from six schools, 679 (18.1%) additional students were identified by screening, representing a 180.1% increase in students identified with behavioral risk or need for mental health interventions. Using a series of stepwise logistic regression analyses, we identified significant predictors of newly identified students including gender, number of office discipline referrals, and externalizing, internalizing, and adaptive behavior ratings. Findings are discussed in relation to opportunities for prevention and the systems needed in an MTSS to meet the needs of newly identified students.

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