Mental Health in Secondary Schools: The Importance of Student Voice and Student Agency

Over the last two decades, there has been a substantial increase in youth mental health concerns (Twenge et al., 2019) which has been made worse by the recent pandemic (CDC, 2020). Schools have increasingly become the primary setting for mental health intervention (Costello et al., 2014). However, there are many students not receiving early intervention services (Anderson et al., 2019). 

Why Secondary Students Are at Higher Risk

Secondary students with mental health challenges are particularly at risk of being overlooked if their symptoms are not easily observable (Suldo et al., 2016). 

Consider a typical school referral. A middle school teacher may have upwards of 200 different students they will teach on a typical school day. During instruction, which types of emotional and behavioral concerns most often get noticed? Research would tell us that teacher referrals will typically identify externalizing (e.g., out of seat, aggressive) behaviors (Kahlberg et al., 2007). These concerns are often most disruptive to classroom instruction. 

Which students and what type of behaviors are missed? Internalizing concerns, such as anxiety and withdrawal, are often the least frequently referred behaviors relative to their true prevalence. 

Middle and high school students are more likely to experience anxiety, stress, and depression than younger students—this further highlights the need to be vigilant for student mental health concerns that are observable and those that may not. 

Moreover, there are certain groups of students (e.g., students from minoritized populations) that are more likely to be identified with externalizing behaviors, resulting in disproportionate outcomes (Skiba et al., 2016). When students with mental health needs do not receive needed intervention, they are more likely to drop out, have poor academic outcomes, and experience increased likelihood of entering the criminal justice system (Skiba et al., 2016). 

Student Voice and Student Agency as Drivers of Mental Health Supports

When teacher referrals are the primary mechanism for driving mental health supports, teachers are relied upon to reliably recognize a full continuum of mental health needs and only refer when a concern reaches a predefined threshold. 

Rather than relying on reactive and often inaccurate referrals, universal screening presents a promising and proactive alternative. Teachers are often the first gate in determining which students will receive timely services. Training teachers in best practices with mental health services can improve overall understanding of mental and behavioral health needs (von der Embse et al., 2018), increase accuracy in identifying risk (Evans et al., 2005), and improve efficacy in facilitating intervention services (Reinke et al., 2011). Given the total time spent with students, teachers are in an ideal position to detect changes in student wellbeing (Johnson et al., 2011). 

Yet, screening from a teacher report is only one half of the equation. Recently established best practice guidelines have highlighted the importance of multiple perspectives in universal screening, specifically incorporating student reports, at the secondary levels (Romer et al., 2020). 

Student voice is essential in reporting mental health needs, rather than just mental health problems. 

Relatedly, assessment of needs as opposed to just problems moves away from a limited, deficit focus, and orients decisions towards malleable and action-oriented services. 

How the Right Universal Screening Tool Unlocks Student Agency and Student Voice to Drive Success

Research supports the use of student self-report screening tools, especially at the secondary level and with internalizing concerns. As noted earlier, there are many high school and middle school students with unrecognized needs. By leveraging teacher and student-reported social-emotional behavior (SEB) screening, schools can engage in a more holistic assessment and help teams gain a more complete picture of a student’s social-emotional functioning and well-being.

This combination of teacher-reported and student-reported SEB screening can also provide information that may be different based upon the context. Returning to the middle school example, students have multiple teachers, and thus their needs may differ based upon setting. 

Lastly, incorporating student voice can be an important conversation starter in communicating needs across school and home environments. School teams can identify patterns of needs as reported by both teachers and students and bring parents into the problem-solving process. Student-report screening can also reveal internalizing concerns that were missed by educators and parents. 

Importantly, using an SEB screening tool such as the SAEBRS (Social, Academic, and Emotional Behavior Risk Screener) can be indicative of both problem behaviors and needed social-emotional skills, aligning to a dual-factor model of mental health (Suldo & Shaffer, 2008). The integration of positive and negative indicators in the decision-making process leads to a more comprehensive understanding (Huebner et al., 2007).

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