Investigating the Effectiveness of Tier II & Tier III Mental Health Supports in Two Rural School Districts

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Mental health difficulties, Assessment, Intervention, Rural education

District Partners

  • Oskaloosa 
  • North Mahaska 
  • Great Prairie 

Project Duration

From 2017 to 2018

Background and Purpose 

Approximately one-fifth of students experience mental health difficulties and cannot fully benefit from the available academic and extracurricular opportunities. Students with mental health difficulties experience a variety of negative outcomes, including lower academic achievement and disengagement from school. Teachers and administrators are also impacted as they spend time supporting their students' mental health and behavior, which led to less time focused on academic instruction and other positive interactions.

School-based mental health programs were being implemented across the country through partnerships with community-based mental health providers; however, rural schools were at a disadvantage because they were located in communities with reduced access to community-based mental health providers. Existing school-based mental health programs, which were developed in large cities, were thus difficult to replicate in rural schools.

This project aimed to supplement existing supports by developing and implementing mental health assessment and intervention supports at Tier II and Tier III within two rural school districts in Iowa. The researcher assessed the effectiveness of the program through both quantitative and qualitative measurements of both student- and systems-level variables. Student-level variables included mental health measures, school behavior, and academic achievement. School-level variables included the amount of time administrators and counselors spent working through crises with students and stakeholder acceptability of program elements.


  • Students who received mental health care through this project improved their scores on the Strengths and Difficulties Questionnaire (SDQ) and Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) and maintained or improved their academic performance
  • The school principal spent less time in crisis with students who accessed school mental health services
  • Most parents were satisfied with the mental health care their children received, although they wished the social worker could see their child more often 

Resulting Publications 

Follow-On Grants 


Nikole Skaar picture
Skaar, Nicole

Assistant Professor, Department of Educational Psychology and Foundations, University of Northern Iowa