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School disengagement is a significant problem experienced by many students and may be an indicator of or resultant from underlying difficulties. Indeed, the first onset of mental health difficulties typically occurs during childhood and adolescence. Utilizing large clinically referred samples of elementary and secondary school students at intake into community and inpatient mental health service agencies across the Province of Ontario, Canada, school disengagement was explored as associated with physical and mental health as well as peer and familial relationships, other and self-directed harm, and service intensity need. Age and sex differences were explored across studies to inform the development and implementation of targetted prevention and intervention programs for promoting school engagement and circumventing life-long consequences across the lifespan. Findings from the first paper indicated that physical and mental health distress were associated with school disengagement, while individual and relational strengths were associated with school engagement among clinically referred elementary and secondary students. Distinct predictive profiles of school disengagement were revealed for school-age children (ages 4 to 11 years) and youth (ages 12 to 18 years). Results from the second paper indicated that school disengagement was strongly associated with other- and self-directed harm among clinically referred elementary and secondary students. Notably, male youth were more likely to be at risk for harm to others, while female youth were more likely to be at risk for harm to self. Findings from the third paper indicated that students who are disengaged in school are two to four times more likely in odds to require high-intensity as compared to low-intensity services at intake into clinical services. Although service intensity need tended to decrease across development, this relationship was more stable for male students as compared to female students. Taken together, findings across the three papers highlight the necessity for early identification of student distress and provision of timely access to intervention. Further, the requirement of service integration across sectors working directly with students and their families is underlined. When school engagement problems are identified early, both immediate and long-term consequences, such as the manifestation of acute distress requiring crisis supports, can be prevented.

Research identifying similar and dissimilar risk factors for directly and indirectly self-injurious behaviours among adolescents is scarce. Due to the wide range of physical and mental health difficulties that may result from self-injurious behaviours, understanding differential risks is important to support at-risk adolescents. To address this gap in the literature, 541 clinically referred children and youth (ages 11-18 years old) were assessed using the interRAI Child and Youth Mental Health Assessment (ChYMH) and Adolescent Supplement. Logistic regression analyses revealed that older adolescents were at an increased risk for both direct and indirect self-injury. Moreover, adolescents who experienced high levels of depressive symptoms, caregiver distress, and neighbourhood violence were at an increased risk for direct self-injury (i.e., nonsuicidal self-injury, suicidal self-injury). In contrast, adolescents who experienced high levels of aggressive behaviour were at an increased risk for indirect self-injury (i.e., substance use). Implications for targetted preventative and intervention strategies are discussed.