Creating Conditions to Promote Wellness in Schools: Systemic change to reduce mental health and substance abuse problems.

Robert Tymann, EdD

I struggled with the title of this article, specifically with the word "reduce." I want to say eradicate or eliminate, but that is not possible. There are too many factors beyond the control of our schools. The National Institute on Drug Abuse, (NIDA) writing about early childhood prevention, states "These behaviors that manifest during adolescents have their roots in the developmental changes that occur earlier - as far back as the prenatal period. While prevention can be effective at any age, it can have particularly strong effects when applied early in a person's life…" We are not able to change the circumstances of our students' lives, but focusing on what we can not do is counterproductive. What can we do?

Our mission is to support every student in their personal and intellectual growth every day.  Students will struggle to "grow" in either area if they have not developed the cognitive regulation, emotional regulation, and social/interpersonal skills appropriate for their developmental stage. Most elementary, middle, and high schools have a program designed to nurture social-emotional competence in our students. These wellness programs provide lesson plans specifically designed to expose students to the problems they will face and the skills they will need. Role-playing is often used to help students develop skills to combat bullying, resist peer pressure, and make the right decisions in general by building their resilience. Support staff meets with students individually and in groups to help them through difficult transitions and develop their resilience. All of these initiatives are well intended and have a positive effect on many of our students. But if you have an honest conversation with any high school principal, mental health problems and related substance abuse are devastating many of our students' lives. Opioids and e-cigarette use have been labeled "epidemics," adolescent deaths by suicide are increasing dramatically, marijuana and alcohol use are ever present. We are working hard but not having enough of an impact on the problem, and for many of our students, we are their best hope for a positive future.  Although the effects of poor mental health reach the public consciousness in late middle school and high school, the earlier we start prevention, the better. NIDA Prevention Principle 6 states, "Prevention programs can be designed to intervene as early as preschool to address risk factors, such as aggressive behavior, poor social skills, and academic difficulties." Districts can do a much better job of giving our students the confidence and skills they need to make healthy choices if we frame this problem with a systems view, a Pre K through 12th-grade mental health initiative focused on prevention and support. This requires district-level leadership, a willingness to accept responsibility for implementation with an understanding of the time required to achieve long-term goals. A team of frontline professionals; teachers, counselors, psychologists, social workers, and community mental health professionals, should design the “nuts and bolts” of the program. The responsibility of keeping the team on task and producing results, often by negotiating a compromise, is the role of district-level administration.

Developing a system-wide mental health initiative requires a clear focus that considers the risk factors affecting students and the protective factors that will help students build resilience. A few quick definitions are required here. "Risk factors are qualities of children and their environments that place children at greater risk of... behavioral problems...protective factors are qualities that promote successful coping and adaptation and thereby reduce those risks." (NIDA, Prevention Principles) "Resilience is that ineffable quality that allows some people to be knocked down by life and come back at least as strong as before. Rather than letting difficulties or failure overcome them and drain their resolve, they find a way to rise from the ashes." (Psychology Today)

A District Mental Health Initiative should be clearly tied to the District Vision that places a priority on graduates having the resilience to handle life's difficulties and the self-awareness to know when to seek assistance. If this type of goal is not included in the District Mission, the mission should be updated.  Being part of the district mission sets it as a priority of the Board of Education and Administration. The goal of the initiative is to minimize "at risk" behaviors in our students by modifying risk factors and developing coping mechanisms as protective factors. A combination of research-based, age-appropriate universal and selective interventions can be implemented system-wide. A District Mission Statement that includes what we want for our graduates, the characteristics, behaviors, and beliefs we want in our staff, and the type of instruction that supports the vision is helpful if the mental health initiative is to stay on track. A vision that puts student mental health as a priority will, of its very nature, support academic achievement. These are two sides of the same coin, you can not have one without the other. A sample “District Vision” that meets this goal is included in the “Works Cited.”

Risk factors and protective factors can be organized into five general domains, the individual, family, school, life events, and social.  Each category has particular risks and protective factors associated with it, but this is a system. All parts are connected and overlap. Any changes in one risk or protective factor in any category will have an effect on how everything interacts.  And this complex system has, at its center, a child struggling to perceive and achieve a positive future.

Risk Factors and Protective Factors by Domain

(Compiled from NIDH website and “Risk and Protective Factors That Influence Children’s Wellbeing” image)

Three "leverage points" to support mental health clearly under the influence of schools are community outreach, supporting transitions, and a supportive school environment. Although discussed here as three broad initiatives, they are interconnected and inextricably part of one district-wide effort. Each leverage point combines universal interventions (all students) and selective interventions (students with elevated risk factors). Most schools are working hard to provide community outreach and support during transition periods.  Both of these areas can benefit from a coordinated Pre K through 12 plan that consistently provides students with as much age-appropriate support as possible. A school environment that intentionally builds protective factors must be developed, students in painful transition periods need appropriate supports, and community outreach is necessary to bring all available resources to bear on risk factors beyond our reach. The ideas below are by no means all-inclusive nor a prescription to fix this problem. It is, I believe, a start at moving a district-wide system in a direction that makes schools more responsive to the cognitive and emotional needs of our students. The changes in the school environment may prove to be the most difficult because they necessitate rethinking some core values of how we "do school."  

Through community outreach, we can educate parents at every opportunity and connect families with multiple risk factors to the appropriate community resources.  The objective is to mitigate some risk factors and strengthen some protective factors. Universal interventions can take the form of mental health/drug prevention forums, "commercials" at all parent meetings, and extensions of the wellness program designed for parents. Selective interventions can be implemented for students and families with elevated risk factors.

Mental health/drug prevention forums are an opportunity to educate parents on prevention and warning signs to be on the watch for.  Building level administration can share with parents what they are experiencing in the schools. Often this results in the "dog and pony show" where administrators tell parents about the great programs they have implemented and what a fantastic school they run.  That may be true, but that is not what is needed. Honest conversations about what we are doing, the behaviors we are seeing, the number of incidents involving mental health issues and substance abuse we deal with, how we deal with them, and how we can work together to support our students are much more productive.  Bringing in expert speakers on addiction, mental health issues, and law enforcement brings credibility to the conversation. This can not be a once a year event. The forums need to be ongoing, well-publicized, and at times that are convenient for parents. Some topics may be for all parents, Pr k - 12th grade, while others may be specific to certain grade levels.  A good practice is to tape all of the forums and have them available on the district website to be viewed by parents who were not able to attend. There are many parent meetings during the evening at school, and few parents can make them all. Traditional parent meetings on other topics can begin with a brief (2 - 3 minutes) "infomercial" that shares a valuable insight, parenting strategy, new paraphernalia to be on the lookout for, or a clip from a recent forum.  This will keep the topic, and the priority the school places on it, front and center.

Selective Interventions include support staff making connections to community mental health supports for families in need.  This can take the form of counseling services, psychiatric services, legal aid, law enforcement, a food pantry, place of worship, etc.  Support staff should be well versed on what is available and payment options that are available for parents. Many areas are beyond the purview of schools, but we can inform parents about the available services.  Selective interventions can also take place within the school in the form of support for students identified as "at risk." Small support groups for students with significant risk factors under the guidance of a trained social worker or counselor can help bolster students’ protective factors.  Classroom teachers can be made aware of the situation and given strategies from the support staff that can add to the students' resilience. Often, it is the classroom teacher who will identify a student in need and recommend them to support staff. Identifying students with elevated risk factors and helping to strengthen their protective factors are directly connected to the supportive school environment discussed below.

A second leverage point is to support students during transition periods to mitigate some of the risk factors and strengthen some protective factors.  Universal transitions include changing schools, usually from 5th to 6th grade and 8th to 9th grade, and the difficult transition from home to school upon entry to pre K or kindergarten.  Supports for selective transitions are needed for new entrants into the school from other districts or countries, students experiencing divorce, bereavement, etc.

For universal transitions, we need to minimize the cultural change at each transition level, either between grade levels or between home and school. If we look at the academic and social culture students live in at school at the beginning of eighth grade and compare it to the academic and social culture they will live in at the end of ninth grade, the differences are stark, and the personal adjustments for each student are significant. This is exacerbated by an imbalance of risk and protective factors for many of our students. In the present system, the transition is abrupt, and the expectations for students adapting are unrealistic in many cases and difficult for all students. Changes are needed on both sides of the transition, eighth grade becoming more like ninth grade and ninth grade becoming more like eighth. The two endpoints may not need to change. If the culture that exists at the beginning of eighth grade and the end of ninth grade is appropriate for students, those endpoints in the transition are fine.  What needs to change is the abrupt transition. The end of the eighth grade is very similar to the beginning of the eighth grade in many schools, as is the beginning and end of the ninth grade. We can adjust expectations, socially and academically, to ease the transition for our students. This type of adjustment is needed for all universal transitions.

One step that should be implemented is to agree on a single mental health program appropriate for all three schools.  Presently, in many districts, each school has a different program. The programs all have the same goals and their own process and unique vocabulary.  We have students adjusting to us, making the transition needlessly more complicated. This change will require staff to be flexible with the programs they have invested significant time and energy in and they feel are benefiting their students. (Additional discussion below)

Selective supports for students in unique circumstances cited above focus on strengthening protective factors and minimizing risk factors. Individual and small group support is crucial for students experiencing life events that represent significant change or make it difficult to see a way out. A caring adult and compassionate peers can help a student visualize a possible positive future and strengthen their resilience.

A third leverage point to support mental health is developing a supportive school environment.  The universal interventions are not only the SEL program we adopt but how we use research on resilience and motivation to inform our daily interactions with students. No faculty feels it does not provide a supportive school environment.  We intend to support every student in their intellectual and personal growth every day. But sometimes the traditions of a school run counter to the science of learning. A supportive school environment will have a system-wide SEL program, a program that connects every student to an adult and peers in a meaningful relationship (advisory), and instruction founded on research on learning.  Best instructional practices are aligned with prevention research (NIDA), which should not be surprising, both seek to foster intrinsic motivation and resilience, two qualities that will serve all of our graduates well. Selective Interventions include assessing students in crisis to determine what supports are needed in the classroom, within the school, and within the community.

A standard Pre K through 12th-grade SEL program seems like a logical step if we are putting the needs of our students first. As mentioned above under "transitions" a universal program will have a consistent vocabulary and philosophy, leaving fewer adjustment for students. In "Preparing for Effective SEL Implementation," Stephanie Jones offers helpful insights into program selection and implementation.  She states “positive outcomes associated with SEL programs (e.g., academic achievement, physical and emotional well-being, etc.) are often less powerful than expected. This may be due to inconsistent or ineffective implementation practices.” I believe positive outcomes will be bolstered by utilizing a system-wide program. SEL programs vary significantly in their content focus, instructional methods, and additional features and support beyond core lessons. (Jones, 2018) This is important when considering the shifts in student adult interactions throughout the school. Establishing an "Advisory Program" as part of the SEL program implementation can provide a powerful forum for delivery of the SEL curriculum,   "An advisory program facilitates…relationships and provides the structure that creates 'connectedness' in a middle school. Connectedness is a characteristic of school cultures in which students have meaningful relationships with adults within the school, are engaged in the school, and feel a sense of belonging to the school." (Schulkind, Foote, 2009) Although advisory is often associated with middle school and is listed as one of nine "essential elements" of any middle school, this type of relationship will benefit students at any age. The research tells us, "the single most common factor for children who develop resilience is at least one stable and committed relationship with a supportive parent, caregiver, or other adults." (Center for the Developing Child, Harvard University)  This is the goal of an advisory program. The presence of at least one caring person in a child's life can provide the support needed for healthy development and learning. (Bernard, 1995) (Truebridge, Bernard 2013) (NIDA) The form of advisory may look different at different grade levels. The core outcome, every student having a meaningful relationship with an adult, can be accomplished in many ways.

A second universal intervention is to implement instructional practices that build/strengthen protective factors. "The curriculum that supports resilience respects the way humans learn." (Bernard, 1995) Empowering students by giving them choices and project-based learning, when it fits the desired instructional outcomes, have been shown to strengthen protective factors. NIDA lists "good grades" as a protective factor. This does not mean everyone gets a trophy.  We need to embrace a growth mindset in ourselves and our students. Students need to experience hard work and the resulting accomplishment that will foster intrinsic motivation and the stick-to-itiveness that is the foundation of resilience. We have to think about the words and actions we use to motivate our students. Mike Anderson's book, What We Say and How We Say It Matter, is a quick read with excellent ideas on how changes in our choice of words can have a positive impact on student motivation. Intrinsic motivation is a critical component of our students' mental health. Being motivated to learn, to succeed, because it is inherently satisfying will help our students when the "carrot or stick" is not present.   Research by Lepper and Green, going back to the 70s and often repeated, highlights that extrinsic motivation, in the form of rewards promised for completion of a task, can reduce student motivation in the absence of rewards. I understand that this is a significant cultural shift for schools that are dominated by extrinsic motivation and compliance. Our tried and true methods of motivating children to be "good students" achieve short term goals at best and may harm some students at worst. This is not to say that there is no place for extrinsic motivation in school. What is needed is a logical balance.

This shift in instructional practices will take significant professional learning and, that most critical resource, time.   Deborah Stipek, Dean of the Graduate School of Education at Stanford University, said “this comes down to teacher preparation and school design. Teachers aren’t trained to design academically rigorous lessons that motivate students in the right way. And schools aren’t set up to give teachers the time to do so. It is possible, though.” (Garcis Mathewson, 2019)  When discussing these types of instructional shifts secondary teachers often say that by the time students reach them that have been trained to learn in a traditional classroom. Yet, I have observed how student steeped in traditional instruction can adjust and flourish in A.P. Capstone courses which exemplify instruction that builds intrinsic motivation and resilience.  But the adjustment should not be necessary. A.P Capstone uses what we know about how humans learn to the benefit of our students. The system must shift, Pre K through 12th Grade, to this type of instruction.

As with any innovation within an organic system, there are many right ways to proceed.  I have shared my ideas for what I feel is a comprehensive plan, well aware that the plan is not the destination but a tool to get the system moving in the right direction. This is not a problem we will "fix," but we can do much better than we are now. Looking at the list of risk factors and protective factors above, we have many leverage points at which we can alter the life trajectory of our students. Many factors we can have a significant influence on, and others we can influence to some degree within our scope of control and to a higher degree by facilitating community connections. We can not change the circumstances of our students' lives, but we can have a significant influence on their life trajectory.

Our work strengthening student's resilience, building the protective factors and buffering the risk factors, starts the first day they enter our schools, and every day after that. What they hear us say and what they see us do, make an impression that can strengthen their resilience to overcome the adversity that is simply a fact of life. This is an incredible responsibility that we all must accept if we are to achieve our mission: To support every student in their intellectual and personal growth every day.

Works Cited

Anderson, Mike. What We Say and How We Say It Matter: Teacher Talk That Improves Student Learning and Behavior. Alexandria, ASCD, 2019.

Bernard, Bonnie. "Fostering Resilience in Children." ERIC Digest, ERIC Resource Center, Aug. 1995, eric.ed.gov/?id=ED386327. Accessed 5 June 2019.

Garcis Mathewson, Tara. "Intrinsic Motivation is the Key to Student Achievement." MindShift, 27 Mar. 2019, Accessed 31 Mar. 2019.

Greene, D., Lepper, M.R. (1974). Intrinsic Motivation: How to Turn Play Into Work. Psychology Today, 49-54.

Greene, D., and M. R. Lepper. "Effects of Extrinsic Rewards on children's subsequent intrinsic interest." Child Development, 1974, pp. 1141-45.

Jones, Stephanie, et al. "Preparing for Effective SEL Implementation." Wallace Foundation.org, 26 Mar. 2018, www.wallacefoundation.org/knowledge-center/Documents/Preparing-for-.... Accessed 6 Apr. 2019.

National Institute on Drug Abuse: Advancing addiction science. National Institute on Drug Abuse, www.drugabuse.gov/. Accessed 5 June 2019.

Truebridge, Sara, and Bonnie Bernard. "Reflections on Resilience." Educational Leadership, vol. 71, no. 1, Sept. 2013, pp. 66-67.

Tymann, Robert. “Sample District Vision.” https://docs.google.com/document/d/1jNHy4TaTo0vKNM0NZhnDRywAlUeWsj6Yu2x0d7AmRD4/edit