Tier 2 Mental Health Interventions in Primary and Secondary Schools: A Scoping Review

Mental health problems in school-aged youth are a risk factor for poor outcomes in adulthood. Although these poor outcomes are well established, most youth with mental health problems continue to experience barriers to receiving appropriate services. Tier 2 interventions are sometimes provided to students who are at risk of developing a mental illness. The aim of this scoping review was to synthesize the peer-reviewed research regarding Tier 2 mental health interventions in primary and secondary school settings. A systematic search of published research was conducted in CINAHL, Education Research Complete, Embase, ERIC, Medline, PsycINFO and SocINDEX electronic databases. This scoping review followed a two-level screening process where articles were screened in duplicate by two blinded reviewers. A total of 288 articles were included in this scoping review. Tier 2 mental health interventions in schools have significantly increased since 1965, increasing to about 24 research publications per year. Interventions mainly targeted youth with behavioural problems (51.04%), social difficulties (21.88%), emotional problems (20.49%), and substance abuse (18.06%). Tier 2 interventions were administered by teachers (58.33%) and most often delivered in a group setting (42.01%). This scoping review demonstrated that Tier 2 mental health interventions in schools are gaining prominence in the literature and primarily target children with externalizing behavioural problems. The flexibility of Tier 2 interventions allows them to be implemented in a variety of settings and treat several symptoms making them ideal for broad-based mental health support in schools.