Tier 1: All students with and without disabilities benefit from Tier 1 services:

All schools need to develop collaborative and creative means of identifying and intervening with children who present with difficulties in their social, behavioral, and emotional development before their problems become so serious as to warrant removal from the regular class in their home school. Tier 1 interventions focus on creating positive, safe school environments, developing mental health literacy, risk reduction, and protective factors enhancement for all children and are targeted to the general or a whole population group that has not been identified on the basis of individual risk and the prevention is desirable for everyone (Robbins, Johnston, Barnett, Hobstetter, Kutash, Duchnowski, & Annis, 2008). Tier 1 interventions focus on indirect care and will often replace the need to develop individual, direct interventions for multiple students who engage in similar inappropriate behaviors (Kutash et. al, 2006). These are policies and practices that target the entire population of a school to promote and enhance wellness by increasing social, emotional, and behavioral skills and improving academic outcomes. This includes: school-wide programs that foster safe and caring learning environments and engage students; are culturally appropriate; promote social, emotional, and behavioral learning; and develop connections between school, home, and community (Lueck & Kelly, 2010). Focusing on both risk reduction of factors predictive of academic challenges and protective mental health factors enhancement is most effective in promoting youth development.

An Important Fact- Typically 80-90% of students are expected to have their needs met with Tier 1 supports, thereby decreasing dependence on Tier 2 or 3 interventions. According to Kelly, Thompson, and Frey (2011), the stronger the primary prevention supports are, the less need, there will likely be for targeted Tier 2 and Tier 3 interventions. Universal approaches should reflect the specific needs of the school population. For example, cognitive-behavioral instruction on anger management techniques may be part of a school-wide strategy delivered to the whole population in one school, while it may be considered a Tier 2 intervention when only provided for some students in another school.

Read Macklem, Chapter 2: Evidence-Based Tier1, Tier 2, and Tier 3 Mental Health Interventions in Schools.

For a more detailed exploration of tiered interventions to support school mental health, please read Chapter 2 in G.L. Macklem’s Evidence-Based School Mental Health Services: Affect Education, Emotion Regulation Training, and Cognitive Behavioral Therapy. It has been uploaded to the folder for your convenience. The chapter provides a table of registries with lists of evidence-based programs—this may be a useful part to highlight. Additionally, there are several Tier 1 programs described in the chapter.

Retrieved from: TOT 1: Occupational Therapy Informed Tier 1 Interventions (2019)

Group Discussion Post:

Take a few moments to review 1 or 2 of the Tier 1 programs and share your thoughts in the Group Discussion titled Tier One Programs —what do you think makes them effective? How might OT be able to support their implementation? Other thoughts?

I think the Macklem (2011) article provides some very good insight into the Tier 1 programs and evidence-based practice mental health programs within the school systems. One of the biggest reasons for instilling tier 1 programs into schools is because they focus on prevention, which can hopefully decrease the money and funding required to insert more individualized programs into the school systems. One of the tier 1 programs Macklem mentions in his article is the Incredible Years (IY) program. This program aims to accomplish two goals, which include “enhancing both social-emotional and academic competence, which includes understanding of feelings and decrease of negative attributions, with a second goal to reduce conduct problems” (Macklem, 2011). This program incorporates not only the children within the schools, but the teachers and parents as well, which I believe make this program very strong. I think one of the biggest issues with education in general is that something that gets implemented in one place and is not carried over to another setting can set the child back from their learning. I like that this IY program is intended to be taught a few times per week in the classroom by the teachers to the children, but it also incorporates home programs that the parent can issue to their children in addition. The program the YI is called the Dina Dinosaur program that works on “training children in emotional literacy, empathy, friendship and communication skills, anger-management, interpersonal problem-solving, and how to be successful in school” (Macklem, 2011). These skills are not only important in the school settings. Children need to be able to have emotional literacy and the ability to make friends and have communication skills in all settings and as they age. I like that this program is taught to young children (kindergarden-2^nd graders) because I think teaching children early is the best way to instill the results these programs like to see. One of the biggest lessons I have learned as a babysitter is that children like rules and guidelines. They behave much better for me when they know what the ground rules are. I have built relationships with the kids I babysit over the years and they know and understand what I expect from them when I am in charge of them.

As an OT, I think that this program will be very important not only from the OT perspective, but I think it can decrease the number of students who are referred to OT for behavioral issues. At the young school-age, children are learning so many life skills and behavior in a public setting is one of them. Some kids can comply with the rules, but other that cannot are punished and sent out of the room affecting their education. I believe a program like this is important because it can allow OT’s to focus on the kids who cannot quite grasp the programs intentions and truly evaluate and treat the kids who need the services the most. I think OT’s can support this programs implementation by providing the teachers and other school staff members the information needed to be successful with a program like this one. I think OT can be beneficial to parents who need help implementing a program like this at home. I also think that OT can provide children the extra help required when they do need to work on other skills that the program may not be teaching them.

Macklem, G.L. (2011). Evidence-based tier 1, tier 2, and tier 3 mental health interventions in schools. Evidence-Based School Mental Health Services: Affect Education, Emotion Regulation Training, and Cognitive Behavioral Therapy, ch.2, 19-37. doi: 10.1007/978-1-4419-7907-2_2

Schools are a busy place. Such calls for action, like school wide mental health promotion, may be perceived as an unrealistic pressure and one to which staff do not have sufficient time to respond to given their other work duties. This is further complicated by the fact that school effectiveness is largely measured according to academic performance, measured by standardized test scores, and a focus on the common core subjects. Many teachers feel they don’t have the time or the space to open up anything new in their curricula. Nonetheless, many teachers find that a lot of their energy is spend addressing social and emotional development and issues as much as they do in supporting intellectual and technical growth (Weare, 2000). This is, in part, due to increased pressures on youth and children that make it more difficult to teach them—they are historically more depressed, more disruptive, and less likely to accept authority (Weare, 2000).

It is important to note that there continues to be evidence that students who are having emotional and social difficulties are perceived as a troublesome and a likely to dilute school performance results through poor achievement, take up too much valuable time, and excluded in greater numbers (Kelly 1997; Smith 1998).

It is vital that those who seek to support high achievement and academic standards and those who seek to promote positive mental, social, and emotional health understand that they are actually on the same side. That is, positive mental health supports academic learning, not simply take time away from it. Students learn best and more effectively when/if they are happy in their work, believe in themselves, like their teachers, connect with adult staff members, and feel school is supporting them (Goleman, 2006; Weare 2000). The influences are reciprocal determinants (work both ways), as it is also clear that academic achievement positively influences students’ levels of happiness, self-esteem, and confidence (Grant, 2004).

Suggesting that schools should concentrate more on social, emotional, and mental health is not simply to add yet another demand to a teacher’s or staff’s already overloaded schedule. Effective social and mental health promotion efforts is directly beneficial to academic attainment, and can therefore help teachers be more effective in meeting the many demands they face.

Retrieved from: TOT 1: Occupational Therapy Informed Tier 1 Interventions (2019)