The Professional Counselor | Volume 13, Issue 3 224 Universal Complete Mental Health Screening Comprehensive school counseling programs are intended to integrate data-driven MTSS to address academic and behavioral concerns (Belser et al., 2016). Within MTSS, all students receive universal core instruction (Tier 1). These universal programs provide approximately 80% of students with what they need to be academically, socially, and emotionally successful. Common Tier 1 supports and programming include reward systems, explicit social–emotional learning lessons, daily mindfulness activities, and modeled schoolwide expectations. With that, approximately 20% of students who receive core instruction may need additional Tier 2 (small group or mentoring) or Tier 3 (individual counseling or community referral) supports to be successful (O'Brennan et al., 2016). MTSS efforts are critical in the early identification and prevention of long-term mental and behavioral health problems (von der Embse, 2018). As such, universal screening data is used to inform which students are in need of additional services beyond Tier 1 (Moore et al., 2019). Additionally, universal screening data helps to align counseling services and supports to the appropriate intensity needed at each tier to meet students’ social–emotional needs (Belser et al., 2016). With advancements from the positive psychology movement, universal mental health screeners have adopted a more strengths-based approach, termed complete mental health screening, to include both psychological distress and strength indicators (Furlong et al., 2018; Moore et al., 2019). Using this approach, students are classified into one of four different mental health groups, according to their severity of psychological distress and their positive strength indicators (Suldo & Shaffer, 2008). The complete mental health group (high strengths, low distress) is typically the largest mental health group to emerge across samples (Suldo et al., 2016) and refers to individuals with optimal wellness (Suldo & Shaffer, 2008). Students with complete mental health are often successful in terms of academic skills and emotional engagement and are likely to only need Tier 1 support (Moore et al., 2019). The symptomatic group has elevated distress and strengths (Moore et al., 2019). Although research on this group is inconsistent, it suggests that the presence of positive strength indicators may act as a protective factor despite the presence of psychological distress (Suldo et al., 2016). The troubled group experiences high distress and low levels of strengths and often has the worst outcomes of the four groups (Moore et al., 2019). Finally, the vulnerable group is those who report low levels of distress and low levels of strengths (Moore et al., 2019). Students in this group are typically excluded from intervention services using traditional screening methods because of their lack of psychopathology (Suldo & Shaffer, 2008). Therefore, incorporating both psychopathology and strengths-based measures provides a more comprehensive conceptualization of students’ functioning (Furlong et al., 2018) and is more accurate in identifying students at each level of MTSS (Suldo & Shaffer, 2008). Despite favorable findings, complete mental health screening is not widely used in school-based assessment practices (Suldo & Shaffer, 2008); in fact, most schools do not use any sort of universal screening tool (Wood & McDaniel, 2009). In contrast to screenings, many schools rely on office discipline referrals to determine whether at-risk students are in need of supplemental support services (Bruhn et al., 2014). However, discipline referrals only identify students who “act out” or struggle academically, and they do not capture students with internalized problems (Bruhn et al., 2014). Therefore, given the prevalence of internalizing concerns such as anxiety and depression among highachieving students (Sanzone & Perez, 2019), coupled with their reluctance to seek help (Peterson, 2009), early college high school programs should use complete mental health screenings to identify and support at-risk, high-achieving students.
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