Supporting Student Mental Health

Between 14-20% of children and adolescents in the United States experience a mental, emotional, or behavioral disorder each year.,12 Despite this significant need, only 10-50% of youth with a diagnosable mental health concern receive treatment, with this rate being lower for minority youth. 2,3,4

Increasing Access to School Mental Health Care
While many children and adolescents in need of mental health services do not receive treatment, the majority of students who do receive treatment receive care in the school setting. 5,6,7,8Access to mental health care in schools reduces many traditional barriers to care including transportation and childcare issues, loss of work/school time and mistrust and stigma. 9 School mental health care also allows for prevention and early detection and treatment of mental health concerns .10,11 The community-based environment of the school setting allows for an ecologically grounded, comprehensive approach to care informed by and translated back to the child’s environment to improve daily functioning .11 It has also been well-documented that school-based mental health prevention and intervention programs can help reduce non-academic barriers to learning. 10,12,13

School nurses are on the frontline of school health. They hold the key to address both student health and mental health issues. School nurses report spending approximately a third of their time addressing student mental health concerns and 30% of students who visit the school nurse present with a mental health concern as their primary issue 14,15,16 . Accordingly, school nurses are a critical part of the school mental health team 17. And, the National Association of School Nurses (NASN) indicates that school nurses work in collaboration with an interdisciplinary team to provide mental health assessment, identification, intervention, referral and follow-up care18.

Mental Health Training Intervention for Health Providers in Schools (MH-TIPS)
Given their pivotal role in student mental health care, school nurses report increased need for professional development in addressing student mental health concerns 15. The NASN, the national Center for School Mental Health at the University of Maryland School of Medicine, and the Center for Mental Health Services in Pediatric Primary Care at The Johns Hopkins Bloomberg School of Public Health developed the Mental Health Training Intervention for Health Providers in Schools (MH-TIPS) to address this need.

MH-TIPS is an innovative in-service training and implementation support system for school health providers aimed at enhancing their competence in managing the needs of students with or at risk for emotional and behavioral difficulties that interfere with learning. The MH-TIPS training includes five core training content components linked to the school nurse context with respect to student mental health issues: 1) Strategies and Skills to Promote Positive and Supportive Interactions for Student Mental Health Issues, 2) Mental Health Identification and Assessment, 3) Mental Health Referral and Resource Mapping, 4) Mental Health Crisis Response and Safety Assessment, 5) Mental Health Intervention Best Practices for School Health Providers and, 6) Psychotropic Medication.

Each of the training content areas was informed through an iterative development process with school nurse experts across the nation, and each is theoretically linked to improvement in the provision of quality mental health care to students with or at risk for disabilities and ultimately to improvement in student outcomes.


The MH-TIPS training process consists of a pre-training seminar, an initial full-day training, two half-day “booster” training sessions, and intensive web-based implementation support, including online skill review, video vignettes, free downloadable resources and a community learning forum. Each training module includes hands on resources designed for delivery in the fast-paced, school health provider context.


Pilot Program and Instructor Access
Currently, MH-TIPS is being piloted in two states, and evaluation is being conducted to ascertain the program’s impact on school nurses’ self-efficacy to address student mental health, knowledge about student mental health, and actual practices related to identifying, approaching, and referring students with mental health concerns. Results from both pilot studies indicate that school nurses find the MH-TIPS training useful, easy to use, likely to help students and relevant to the work that they do. School nurses also demonstrated increased mental health knowledge and confidence and preparedness to address student mental health concerns after completing the MH-TIPS training.

The entire MH-TIPS curriculum is currently available, free of charge, via an interactive online training platform at The MH-TIPS in-person training was adapted to be offered online and includes all content of the in-person training but the online course is shorter in length as opportunities for behavioral rehearsal and skill practice are not available as they are in the in-person training. The MH-TIPS interactive online platform includes implementation training videos, school nurse mental health video vignettes, downloadable resources and tools, frequently asked questions and interviews with experts. Continuing education credits are available upon completion of the online curriculum.

The MH-TIPS program has the potential to increase school nurse ability to address student mental health concerns. It also supports the expansion of the capacity of school-based professionals to address the critical need for additional mental health care for children and adolescents and facilitate comprehensive, interprofessional mental health care both within the school and community.


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17. Bohnenkamp JH, Stephan SH, Bobo N. Supporting Student Mental Health: The Role of the School Nurse in Coordinated School Mental Health Care. Psychol Sch. 2015;52(7):714-727. doi:10.1002/pits.21851.

18. National Association of School Nurses. Position Statement- Mental Health of Students. Silver Spring, MD; 2013.

Jill Haak Bohnenkamp is assistant professor, Division of Child and Adolescent PsychiatryUniversity of Maryland School of Medicine. Sharon Hoover Stephan is associate professor, professor, Division of Child and Adolescent PsychiatryUniversity of Maryland School of Medicine. Dian Baker is professor, School of Nursing, California State University Sacrament. Nichole Bobo, MSN, RN, Lawrence Wissow, M.D., MPH, Donna Mazyck, MS, RN, NCSN, NCC also contributed to this article.

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