A Snapshot of School-Based Mental Health and Substance Abuse in Canada

Abstract

French

The Mental Health Commission of Canada supported a comprehensive research project to determine the current state of mental health and substance use programs and practices in Canadian schools. The School-Based Mental Health and Substance Abuse Consortium is made up of a group of 40 leading Canadian researchers, policy makers, and practitioners. The Consortium systematically reviewed literature from around the world, conducted a program scan (147 programs) of current practices in Canadian schools, and distributed a national survey to school boards (n = 177) and schools (n = 643) seeking input on the state of knowledge and practice in child and youth mental health and substance abuse. This information is being shared with policy makers and school boards to help inform the delivery of future mental health services in Canada’s schools.

Keywords

schools mental health substance abuse national

School-Based Mental Health

Many factors have inspired the current focus on school-based mental health and substance abuse (SBMHSA). First, it has been established that a significant proportion of children and youth manifest mental health problems at any point in time (Boyle & Georgiades, 2009; Offord et al., 1987; Waddell, McEwan, Shepherd, Offord, & Hua, 2005). In fact, research has revealed that the majority of adult mental health disorders originate in childhood, with 50% emerging before the age of 14 and 75% by the age of 24 (Kessler, Berglund, Demler, Jin, & Walters, 2005). Furthermore, the evidence suggests that most children in need of interventions do not receive them (Offord et al., 1987; Rohde, Lewinsohn, & Seeley, 1991). Given the significant burden of suffering posed by mental health problems and the associated sequelae (e.g., academic failure, involvement with the child welfare and justice systems, unemployment), there is strong impetus to identify problems and to intervene early.

Many practitioners, researchers, and policy analysts have converged on the recommendation to adopt a public health approach to addressing mental health problems, optimizing the promise of natural settings for intervention, such as schools (Kutash, Duchnowski, & Lynn, 2006; Standing Senate Committee on Social Affairs, Science and Technology, 2006; Waddell et al., 2005). This approach provides access for all children and youth, bolstering social and emotional skills broadly, not just for those identified with difficulties. At the same time, however, universal programming can reduce the stigma associated with mental health problems and may facilitate access to intervention for children and youth who would normally not seek help. Because there will always remain a considerable number of young people who will develop mental illness requiring treatment, it is important to develop a school-based framework that addresses both mental health and mental disorder, while addressing the knowledge, skills, and attitudes that will foster help seeking in a timely manner.

This recognition that schools represent an excellent place to intervene to support child and youth mental health converges with a wave of concern among educators, and education systems, relating to student mental health and substance abuse issues. In 2009, the International Association of Child and Adolescent Mental Health and Schools and the International Confederation of Principals (2009) published a survey of 110 school principals from 25 countries. The data indicated that 90% of the principals believed that mental health problems had an important impact on academic achievement and that approximately 20% of their students needed intervention. A scan of 27 Ontario boards of education revealed a high level of concern for student mental health and substance abuse issues and a strong perceived link between student emotional well-being and academic achievement (Short, Ferguson, & Santor, 2009). Despite this uniform high level of concern, Ontario educators judged themselves and their systems as poorly prepared to identify and manage student mental health and substance abuse needs. In addition, they identified the need for increased leadership, training, and support to improve the capacity to identify and intervene appropriately to student needs.

The School-Based Mental Health and Substance Abuse Consortium

The importance of moving to implement school-based mental health services on a broad scale has been outlined and emphasized in academic, policy, and practice contexts across many jurisdictions (Kutash et al., 2006; National Research Council & Institute of Medicine, 2009; Santor, Short, & Ferguson, 2009; Standing Senate Committee on Social Affairs, Science and Technology, 2006; Weist & Murray, 2007). Information was lacking, however, with respect to Canadian initiatives in this regard. The Child and Youth Advisory Committee of the Mental Health Commission of Canada (MHCC), recognizing this gap, developed a Canadian initiative to understand what is known about effective SBMHSA programs and to discover the current context of Canadian school systems in this area. The focus for the Request for Proposals, issued in 2008, was on developing a broad framework and practical recommendations on SBMHSA services that would be applicable across geography and jurisdictions. Four key deliverables were identified: (a) a synthesis of the national and international literature related to frameworks and best practices in wellness promotion and SBMHSA prevention, early intervention, and treatment; (b) an environmental scan of existing programs and services in Canada; (c) a national survey of school districts related to their needs and practices; and (d) knowledge translation and exchange (KTE) activities, including an interactive national symposium for key stakeholders.

The SBMHSA Consortium represents a cross-disciplinary, cross-sectoral, and geographically diverse set of leaders in research, policy, and practice. The Consortium not only sought to respond to this Request for Proposals but also saw itself as an active participant in the implementation of the plan that would result from this initiative. Stakeholders were invited to join the Consortium based on their recognized excellence in the field, their content and/or methodological expertise, their links to key networks and organizations, and their commitment to working together for Canadian children and youth. The Consortium was organized with Core Members as well as Key Stakeholder Members. Core members were leaders in the field with strong teams at their disposal. Key Stakeholder Members include those who were affiliated with existing teams, those with links to specific constituencies (i.e., specific school boards, aboriginal populations, cultural groups), and/or those with a specialized skill set that adds capacity to the Consortium as a whole. Collectively, the Consortium represents a growing community of practice where new knowledge can be generated, existing knowledge can be synthesized, and best and emerging models of practice can be shared and further evolved. The proposal to the MHCC was successful, with the Ontario Centre of Excellence for Child and Youth Mental Health being identified as the Consortium lead throughout the project. The Consortium organized and undertook its work in four teams, each with leadership from core members and participation from both core and stakeholder members. The Review, Scan, Survey, and Knowledge Exchange/Translation teams each undertook work consistent with the main deliverables identified by the MHCC.

Review Findings

The systematic synthesis of reviews was conducted by Directions Evidence and Policy Research Group on behalf of the Consortium. The review synthesizes findings from 94 systematic reviews and meta-analyses conducted prior to January 2010. The team constructed inclusion criteria for high-quality research and screened 363 reviews in school-based mental health promotion, prevention, and intervention.

Mental Health Promotion

An essential advantage of school-based programming is the opportunity to promote positive mental health of all students rather than focus on those identified as having mental health or behavioural problems. Such programs are designed to promote student social skills and self-concept and to draw on a variety of skill training, role-playing, positive feedback, modelling, and self-reflection techniques with even very young students. Over all, the results were encouraging and the following conclusions are warranted:

Universal programs can be effective in improving the well-being of children and youth.

Social skills training/social emotional learning can be effective in bolstering student coping ability broadly and in addressing an array of emotional and behavioural problems.

In general, programs are more effective when they involve the whole school and if they are implemented over more than 1 year.

Prevention Programs

The evidence on prevention of depressed mood, anxiety, and externalizing problems is clear; there are effective school-based approaches to preventing these problems. The following conclusions are warranted:

School-based behavioural and cognitive–behavioural programs, designed to prevent problems like depressed mood and anxiety can be effective in reducing symptoms.

For such mood problems, the best approaches are skill based and targeted (developing competencies and protective factors) rather than just delivering information at a universal level (psycho-educational).

School-based behavioural and cognitive–behavioural programs, designed to prevent problems with aggression and conduct can be effective in reducing symptoms.

For these externalizing behaviours, the best approaches focus on prosocial skill development, conflict resolution, anger management, and stress management.

Screening for mental health issues combined with effective early interventions can be a useful approach to prevention, but care must be taken to deal with the potential for stigmatization of students identified as having mental health issues.

The literature on suicide prevention is complex and not yet conclusive. However, strategies such as school-based peer identification and response training (how to recognize risk and promote help seeking), family support, appropriate skill development, and professional training for mental health staff and educators appear to be helpful. Early identification and treatment of mental health problems are key components of suicide prevention.

The results for school-based prevention of substance abuse are mixed. Approaches using interactive methods with dialogue and focusing on resistance education and life skills (decision making, assertiveness, problem solving) can be effective. There is some evidence that peer involvement and collaborating with external contributors are helpful in this area.

Programs that involve the whole school and families and that extend over more than 1 year are more effective as preventions.

These findings are consistent with evidence from a large-scale meta-analysis showing conclusively that universal prevention programs that are school based work on several levels (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011).

Intervention and Care

There have been systematic clinical trials of providing school-based intervention for a wide array of mental health disorders. The evidence available at this point in time warrants a number of conclusions:

School-based behavioural and cognitive–behavioural interventions are more effective in treating depressed mood and anxiety problems than general counselling.

For these internalizing disorders, the best approaches are skill based and include elements such as social and problem-solving skills, active coping, and cognitive restructuring. Successful programs can be delivered to individuals or groups.

School-based behavioural and cognitive–behavioural programs are effective in treating problems with aggression and conduct.

The most effective approaches for externalizing disorders focus on techniques such as recognizing stimuli that evoke negative responses, resisting aggressive responses and implementing alternative strategies, and skill building in the areas of self-control, perspective taking, and conflict resolution. Although group treatments have been shown to have positive effects, care has to be exercised to avoid contagion effects when congregating students with disruptive behaviours.

The review did not yield an evidence base related to substance abuse treatments at school.

In summary, the review found clear evidence for the effectiveness of specific school-based strategies for mental health promotion and prevention and treatment of internalizing and externalizing disorders but no clear evidence yet to support school-based treatment of substance use problems. The review also pointed to a number of critical implementation variables. For example, it clarified that programming in this area is not benign and that selecting and implementing strategies must be done with care and planning to ensure no harm to individuals or groups. An important element for success is the match between the program and the needs and resources of the setting in which it is to be implemented. Also, to be effective, personnel need training and support to ensure that strategies are delivered with fidelity to the original program’s methodology. Finally, programs require monitoring of process and outcomes to make sure whether they are achieving the desired results or will require modification for the local context. Successful implementation requires dedicated leadership, proper preparation of the organization and ongoing support for implementation, treatment integrity, and evaluation of program outcomes.

Scan Findings

The SBMHSA Consortium Scan was designed to gather information about school mental health and substance use programs, models, and initiatives currently implemented in Canada.

Scan Development, Recruitment, and Administration

Two sampling strategies were put into place for the SBMHSA scan. First, a link was distributed nationwide to Consortium members and their networks. The link allowed individuals to identify and provide details of promising SBMHSA programs, models, or initiatives by completing an online nomination form. Second, project team members reviewed existing web-based databases and contacted additional key informants to identify and nominate promising programs from around the country. One or all of the following criteria needed to be met in order to be included in the scan:

An established and emerging SBMHSA school-linked or school-based program, model, or initiative developed and currently being implemented in Canada

A Canadian implementation of SBMHSA international programs

An SBMHSA program targeting students up to Grade 12

Community and educational initiatives for aboriginal populations that involve physical, emotional, social, or spiritual components

All nominated programs were invited to participate. More than 200 invitations were sent out; 53 programs did not respond to our request, leaving us with a participation rate of 73.5%. In all, 147 interviews were completed from late September 2010 to mid January 2012.

Hour-long individual telephone interviews were scheduled and conducted by one of the four members of the scan team who were trained in the interview protocol. Participants could choose to complete their interview in either official languages (French or English). The interviewers adopted a semistructured open-ended interview protocol. The interview was adapted from Short et al. (2009). In addition to descriptive background information, the interview included 32 open-ended program-related questions, including the following: etiology of program adoption, focus, approach, target audience, level of partnership involvement, and challenges and enablers associated with implementation, as well level of program evaluation. Following the interview, participants were given an opportunity to review their responses. Several respondents also sent a variety of resources such as manuals, pamphlets, and reviews to supply an additional source of information on their programs. All of these materials were archived by program.

Scan Demographics

Programs from all Canadian provinces and territories were represented in the scan, with the largest number of respondents being from the province of Ontario (n = 61). For the purpose of the scan, school-based programs were defined as programs being implemented within the school setting and or built into the curriculum. School-based mental health programs focus on mental health promotion, prevention, identification, and delivery (Short et al., 2009). Several of the school-linked programs were also nominated for our scan. School-linked programs were defined as referrals from schools to outside agencies or community agencies delivering presentations and/or workshops within the school environment. The final sample contained 87 school-based programs and 58 school-linked programs. In total, we had 9 French-language programs in our final sample. Programs were also broken down by area of focus. In all, 17% of our sample was substance abuse programs, 51% mental health programs, and 32% targeted both areas.

Scan Findings

Results from the National Scan were analyzed individually for each program and organized in a searchable database (see the Knowledge Translation and Exchange section) as well as collapsed across programs for an overall picture of the Canadian context. Main findings across programs include the following:

The vast majority of programs were developed/implemented based on an identified need at the school and/or community level (75%).

There was a disproportionate number of programs serving students in Grade 9 to 12 relative to those in younger grades.

Programs tended to focus primarily on one of three intended goals: (a) risk behaviour prevention (50%), (b) prosocial skill development (41%), and (c) mental health literacy (37%).

Key barriers to implementation and sustainability include the following: funding, buy-in, financial barriers, time, and capacity.

Key enablers to program implementation include the following: buy-in, partnerships, capacity (staff, funding), an identified need, and leadership.

Partnerships were described as key for program implementation. However, there was limited youth and parent/family involvement in program design/implementation.

School-board buy-in was identified as a critical component to a program’s success. A majority of programs (74%) had established a working relationship with school boards.

Less than half of the respondents indicated that their programs were subject to evaluation, with great discrepancy as to what constituted a formal evaluation. Furthermore, overall there was a weak link to the evidence base suggesting that schools and school boards were not taking full advantage of what the literature had to offer around the issue of programming.

Limitations to the scanning process must be considered when interpreting the findings. The sampling process was not exhaustive, and many programs would not have been identified in the nomination process. Scan interviews were undertaken with a single respondent per program who may have had limited information on certain domains being scanned (e.g., program development, financial matters, and evaluation).

Key recommendations from the Scan results include the following:

Models for system planning in the identification of school-based mental health and addictions needs as well as for system-wide implementation efforts should be identified and shared across jurisdictions.

In spite of extensive efforts to identify current practices across Canada, many programs were not identified, and most programs change over time. Given the great interest in sharing this information across jurisdictions, we suggest an Evergreen approach to capturing and sharing this information over time.

Decision support tools should be identified/developed and made available to the field to assist any given jurisdiction in making an informed choice about which available program or practice supported by evidence would be appropriate and likely successfully implemented within their jurisdiction.

The limited link to the evidence base is worrisome. A compendium of practices with specific information regarding the evidence to support their use would be immensely helpful to the field. This should link the evidence to the resources required for implementation with fidelity within different context (cultural, geographic, etc.).

Program evaluation templates should be developed across program areas with the identification of common tools that can be applied across jurisdictions. Technical support for program evaluation should be available regionally/provincially, with clear linkages for national roll-up of program evaluation data (process, outcome, and cost-effectiveness data).

Efforts for the meaningful inclusion of students and their families in the mental health and addictions services being offered in schools should be identified as a priority as part of a comprehensive system-wide approach to school-based mental health.

It is clear from the scan data that there is significant disparity in the use of terminology in child and youth mental health. A common glossary of terms should be developed across sectors to facilitate partnership and meaningful communication.

Survey Findings

The national SBMHSA Survey was designed to describe the status of school mental health and substance use service delivery in Canadian schools and school boards. It included items related to student mental health needs, available programs and services, training approaches, and implementation issues.

Survey Development, Recruitment, and Administration

Two versions of the survey were created, one to collect information at a district level and a second for school-level respondents. These draft versions were piloted with 17 respondents across four provinces. Final surveys were prepared for online administration in both English and French. To recruit participants, an invitation was sent to 383 school boards across Canada, via Directors and Superintendents of Education in May 2011. They were asked to send the link to every principal in their system, requesting that they forward the link to the individual in their school who is most knowledgeable about school mental health needs and services. Directors were also asked to identify one representative to complete a survey on behalf of the school board. Those who agreed to participate reviewed an online consent form and completed items via survey software at their convenience during the survey period. At the end of June, the surveys were closed and the responses were tallied. Because the late spring period has many competing demands for schools, the survey was reopened in the fall of 2011. Between October and December, three reminders were sent out, and a research assistant made personal contact with all English-speaking boards. The surveys remained open until late December 2011.

Survey Demographics

Representatives from a total of 177 school districts and 643 schools completed the survey. All provinces and territories were represented, but most respondents were from Ontario, Alberta, British Columbia, and Manitoba. Communities varied by size and rural/urban composition. Most individuals completed the English version of the survey (>90%). The majority of those representing schools were from the elementary panel (70%). Of the respondents, 40% to 50% indicated that they had more than 10 years of experience in school mental health.

Survey Findings

The survey yielded information about the status of school mental health in Canada, in many specific areas. A few key highlights are summarized below:

Approximately 85% of board-level respondents indicated they were concerned or very concerned about student mental health and/or substance use. Fewer school-level respondents expressed this level of concern (65%). More than 80% of respondents indicated that there are unmet student mental health and/or substance use needs in their board or school.

At a board level, respondents indicated that problems with attention, learning, substance use, anxiety, and bullying/social relationships were the most common in their schools. School personnel echoed these as primary concerns but ranked anxiety and depression as being more common than substance use.

Research suggests there are a number of system-level conditions that are critical for effective school mental health to flourish (Weist et al., 2005). On the survey, respondents indicated that some of these conditions are in place, such as using a team approach to service delivery that includes the perspectives of both mental health professionals and educators (>90% of respondents), but system-level gaps were also noted (e.g., lack of a clear protocol and agreements defining the pathway to service in their community, insufficient professional development).

Boards and schools were asked to report on their stage of implementation for each service category in school mental health, from mental health promotion to prevention to intervention and ongoing care. Few boards or schools provide coordinated, evidence-based services across the continuum of care. Most indicated that they were at a level of partial implementation with respect to mental health promotion and prevention programming. More board-level respondents reported being at full implementation or sustainability for intervention and ongoing care. Respondents indicated that, in this area, special programs and individual/group counselling delivered by an educator were more prevalent than the use of evidence-based therapy provided by a trained mental health professional.

The most commonly identified challenges to implementation were (a) insufficient funding, services, and staff to meet the demand; (b) a need for parent awareness and engagement; (c) a need for more prevention/promotion programming; (d) a need for more professional development; and (e) stigma.

Summary

There are few differences in perspective across survey versions, though needs around training, collaboration, and implementation supports were particularly highlighted at the school level. The consensus is that school boards in Canada do not yet have the organizational conditions in place to deliver coordinated, evidence-based strategies across the continuum of care. Although district and school teams are growing, and boards are beginning to develop policies, needed infrastructure for effective school mental health is lacking (e.g., protocols for decision making, systematic training, role clarity). Respondents indicated that the emphasis in boards continues to be on intervention services for high-needs students rather than on mental health promotion and prevention. The full continuum of care is not being addressed in a proactive, even manner. The field is calling for more professional development for educators, particularly in relation to mental health promotion and prevention, recognizing signs and symptoms of mental health problems, and engaging families.

Knowledge Translation and Exchange

Communicating the full suite of findings from the SBMHSA project to decision makers at the policy and practice level is an important step towards identifying national and local gaps in school mental health and working to enhance service delivery in schools and communities. Creating effective knowledge-sharing vehicles and processes related to the SBMHSA project has been the task of the KTE Team. The work of this team has been informed by the growing literature on KTE, an emerging science that focuses on the space between research and practice and on methods for asserting bidirectional influence on these two worlds. There are many models for effective KTE (Mitton, Adair, McKenzie, Patten, & Perry, 2007; Straus, Tetroe, & Graham, 2009; Sudsawad, 2007). Most of the current thinking favours iterative, reciprocal approaches that engage knowledge audiences early in the process of exchange. In contrast with traditional means of disseminating research-based information, such as conferences and practice guidelines, the available KTE research highlights the importance of identifying key mobilizers and sharing information over time in small groups, with opportunity for dialogue and ongoing coaching from an esteemed expert in the field (Barwick et al., 2005; Cordingley, Bell, Thomason, & Firth, 2005; Grol & Grimshaw, 2003; Rowling, 2009). Drawing on this literature, the KTE Team created a six-phase plan for collating and sharing the findings of the SBMHSA synthesis, scan, and survey: (a) exploration, (b) early engagement, (c) KTE experimentation, (d) KTE methods, (e) translation, and (f) reporting.

Exploration

At the onset of the SBMHSA project, the KTE Team engaged in information-gathering from key informants across the country. A total of 18 individuals were interviewed, representing a range of stakeholders from across sectors and disciplines and roles. In addition, the KTE Team gathered information about other national and provincial initiatives emerging in the school mental health landscape and made contact with leaders from several key organizations to work towards alignment of initiatives.

Early Engagement

The SBMHSA Consortium used an integrated KTE approach (Straus et al., 2009) that drew on member networks and capitalized on existing events where participants gathered to discuss school mental health. From 2009 to 2012, members of the KTE team presented information and conducted consultations related to the SBMHSA initiative at many gatherings of education professionals across the country. In the spirit of identifying key mobilizers, the SBMHSA Consortium engaged with lead provincial stakeholder groups to provide information and to build momentum for school mental health. In British Columbia and Ontario, this coincided with the development of provincial coalitions that brought together organizations from across sectors to create powerful agents of change for school and community mental health.

KTE Experimentation

Members of the KTE Team explored audience preferences for KTE techniques with a view to guiding recommendations to the MHCC about future directions for knowledge sharing in school mental health. For example, the findings from a discrete conjoint analysis, an in-kind contribution from a member of the KTE Team, revealed that educators favour information that is delivered by an engaging expert and that such presenter qualities exert more influence than any other of the attributes considered (Cunningham et al., 2011). In contrast, Internet approaches and strategies mandated provincially are not preferred. In another area of experimentation, the KTE Team assembled a national roundtable on the topic of Educator Mental Health Literacy. A team of education professionals, researchers, and product developers met by web meeting to create a directory of mental health literacy products supported by a decision support tool for education leaders. Learnings from this eclectic group have also been used to create a list of recommendations for future work in educator professional development. Finally, a KTE Team member created a webinar series on the topic of implementation in school mental health, in part to determine the utility and reach of this method. Content and process findings from have been recorded.

KTE Methods

The KTE Team adopted two central vehicles for broad knowledge sharing in relation to the findings from the SBMHSA Project: a dedicated web space and a national symposium. With the help of the MHCC, an interactive site was created to house SBMHSA products. The National Symposium on Child and Youth Mental Health was held in Calgary in May 2012 and engaged approximately 250 education and mental health professionals, parents, and youth. The event was simultaneously broadcast to a virtual audience of approximately 100 participants. At this event, results from the synthesis, scan, and survey were released. In addition, panels presented on aligned national and provincial initiatives and implementation issues. An international panel, members of the Board of Directors of The International Association of Child and Adolescent Mental Health and Schools Society, offered insights based on experiences in their home countries.

Translation

Findings from the synthesis, scan, and survey were written up in formal comprehensive reports by the team leads. The KTE Team collated the highlights from each of these information sources to create summary documents called BLAMs (Bottom Line Actionable Messages) that were written primarily for policy and practice audiences. In addition, the KTE Team created a policy brief, a set of survey recommendations for senior leaders, and an integrated report summarizing the findings of the scan against that of the synthesis of evidence-based findings. A searchable database of all of the nominated programs from the national scan has been created to assist school boards in learning about existing activities from across the country (by focus area, location, population served, etc.).

Reporting

A metareport will be submitted to the MHCC summarizing the findings from the SBMHSA synthesis of reviews, scan, and survey. This report will also feature recommendations about future knowledge sharing activities.

Conclusion and Overarching Recommendations

Albeit not necessarily the definitive piece of work on SBMHSA in a Canadian context, because of its scope and breadth the preceding does have the potential to make a significant contribution to research, policy, and practice in Canada and beyond. Based on the evidence from both research and practice, the SBMHSA Consortium offers the following overarching recommendations for the consideration of all stakeholders in SBMHSA in Canada. The present findings point to a need for the following:

Attention to organizational conditions for effective school mental health at the provincial, district and school/community level: Organizational conditions include protocols for decision making, systematic training, role clarity, implementation, collaboration, and system communication. Ensuring adequate numbers of trained mental health professionals in schools is also part of this required commitment if we are to be successful across the continuum of care.

Investment in evidence-informed mental health promotion/social emotional learning initiatives within a school context: This includes a method for organizing the current patchwork of mental health programs in Canada, maintaining an updated directory of evidence-informed practices, and scaling up of identified best in class programming.

Systematic professional learning in mental health for educators, parents, and students is needed.

Rigorous evaluation of untested but research-informed approaches, and careful consideration of the continuation of programs that are inconsistent with the evidence base: More foundational research is clearly needed in certain areas—most critically, substance abuse prevention and intervention in schools, suicide prevention and postvention practices, educator mental health literacy and mental health for schools with special populations.

Because schools are an excellent place to promote positive mental health, more needs to be done to take advantage of the growing number of school/community partnerships, coalitions, and networks focused on moving the field forward. Increased coordination and sharing across provinces and territories is also needed, building on the solid work several provinces have initiated to address key policy issues. Inclusive partnerships also must include the meaningful participation of young people and their families.

This project is important not only for the results that it obtained but also for the process that it followed to obtain and disseminate these results. The KTE strategy developed here is already being used as template for other projects initiated by the MHCC. The extent of the partnership and collaboration that has been initiated and extended through the creation of the Consortium provides a significant opportunity for better alignment of efforts in school-based mental health nationally. The Consortium also represents the nucleus for ongoing cohesive research and practice in this area for Canada for years to come.

Findings from the SBMHSA Project are already being shared internationally as others struggle with similar issues to the ones identified here. Global opportunities for collaboration have been enhanced as leaders in SBMHSA seek to align their efforts. Collectively, we have the opportunity to finally stimulate real change not only for our schools and our communities but also, more important, for our children and youth and their families.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Ian Manion, PhD, CPsych, is a clinician scientist with interest in mental health promotion, youth depression, and suicide. He is the Executive Director for the Ontario Centre of Excellence for Child and Youth Mental Health; inaugural Co-Chair of the National Infant, Child and Youth Mental Health Consortium; Principal Lead for the National School-Based Mental Health and Substance Use Consortium; and a clinical professor in the School of Psychology at the University of Ottawa. He is cofounder of Youth Net/Réseau Ado, a bilingual community-based mental health promotion program with satellites across Canada.

Kathy H. Short, PhD, CPsych, is a clinical child psychologist with research and practice interests that focus on school mental health promotion, knowledge mobilization, and implementation science. She is the director of School Mental Health ASSIST, a provincial team that is designed to help Ontario school boards support student mental health and well-being. She leads the Knowledge Translation and Exchange Team for the SBMHSA Consortium and is a member of the U.S.–Canada Alliance for School Mental Health and of the Board of Directors for the International Alliance for Child and Adolescent Mental Health in Schools.

Bruce Ferguson, PhD, CPsych, is a psychologist and researcher who has divided his career between university teaching and health system leadership roles. He is the Director, Community Health Systems Resource Group, at the Hospital for Sick Children, as well as a professor of psychiatry and psychology at the Dalla Lana School of Public Health at the University of Toronto. He coled the Review and Survey teams for the SBMHSA Consortium. His current focus is on improving the life outcomes of children and youth by improving the quality of the community services they receive and building community capacity to support children, youth, and families.

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