Education, Faculty of
Educational and Counselling Psychology, and Special Education (ECPS), Department of
DSpace
UBCV
Ruddy, Alexandra Michelle
Doctor of Philosophy - PhD
University of British Columbia
A growing number of Canadian adolescents are experiencing mental health difficulties, many of whom will require or seek support at school. Schools, including those across British Columbia (BC), are widely becoming a primary environment in which students can receive support for their mental health. While the BC government has made several efforts through school-based, inclusive education policies and initiatives to support students with mental health needs, the ways in which secondary schools are providing support to its students who are struggling with their mental health has not been empirically studied. Using a case study approach, the purpose of this study was to explore and understand the ways in which a secondary school in the Lower Mainland of BC provides support, through its practices and overall climate, for student mental health. Collected data included school observations and interviews with students, parents, teachers, educational assistants, a youth engagement worker, school administrators, as well as school counsellors and a school psychologist. Interview data were analyzed using Braun and Clarke’s reflexive thematic analysis. Five themes and 16 subthemes were identified including Supportive Psychosocial Climate (Relationships are Foundational and Build Connection, Creating Safe Environments), Availability of Supports (Understanding Adults and Flexible Practices, IEP as a Communication Tool, Pathways is a “Game Changer”), Approaches to Support (Supporting the Whole Child, Advocating on the Student’s Behalf, Collaborating as a Team), Acknowledging Boundaries (The School’s Role, “I’m Not a Counsellor,” Parents Finding Balance in Their Role), Challenges to Providing Mental Health Support (Systemic Barriers, Limitations to IEPs and Accommodations, Impact of Increasing Mental Health Needs in the Classroom, Mental Health Education Lacks Meaning, Meeting the Needs of Parents ). Bronfenbrenner’s Ecological Systems Theory was applied as an organizational framework to demonstrate the multilayered context in which the school provides mental health support to students. Findings highlight the many systemic and school-specific successes and challenges encountered in supporting students experiencing mental health challenges. Practical implications and directions for future research are discussed in the context of study findings.
SCHOOL-BASED SUPPORT FOR STUDENTS EXPERIENCING MENTAL HEALTH CHALLENGES: A CASE STUDY by ALEXANDRA MICHELLE RUDDY M.A., University of British Columbia, 2019 M.Sc., University College London Institute of Education, 2015 B.A. (Hons), Queen’s University, 2013 A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (School and Applied Child Psychology) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) October 2025 © Alexandra Michelle Ruddy, 2025 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, the dissertation entitled: School-based support for students experiencing mental health challenges: A case study submitted by Alexandra Michelle Ruddy in partial fulfilment of the requirements for the degree of Doctor of Philosophy in School and Applied Child Psychology Examining Committee: Dr. Laurie Ford, Professor, Department of Educational and Counselling Psychology, UBC Supervisor Dr. Janet Jamieson, Professor Emeritus, Department of Educational and Counselling Psychology, UBC Supervisory Committee Member Dr. G. Thomas Schanding, Jr., Department Head & Associate Professor, Department of Educational and Counselling Psychology, UBC Supervisory Committee Member Dr. Nicole Johnson, Associate Professor, Department of Educational and Counselling Psychology, UBC University Examiner Dr. Sandra Scott, Professor, Department of Curriculum & Pedagogy, UBC University Examiner Dr. Kelly Dean Schwartz, Associate Professor, Werklund School of Education, University of Calgary External Examiner iii Abstract A growing number of Canadian adolescents are experiencing mental health difficulties, many of whom will require or seek support at school. Schools, including those across British Columbia (BC), are widely becoming a primary environment in which students can receive support for their mental health. While the BC government has made several efforts through school-based, inclusive education policies and initiatives to support students with mental health needs, the ways in which secondary schools are providing support to its students who are struggling with their mental health has not been empirically studied. Using a case study approach, the purpose of this study was to explore and understand the ways in which a secondary school in the Lower Mainland of BC provides support, through its practices and overall climate, for student mental health. Collected data included school observations and interviews with students, parents, teachers, educational assistants, a youth engagement worker, school administrators, as well as school counsellors and a school psychologist. Interview data were analyzed using Braun and Clarke’s reflexive thematic analysis. Five themes and 16 subthemes were identified including Supportive Psychosocial Climate (Relationships are Foundational and Build Connection, Creating Safe Environments), Availability of Supports (Understanding Adults and Flexible Practices, IEP as a Communication Tool, Pathways is a “Game Changer”), Approaches to Support (Supporting the Whole Child, Advocating on the Student’s Behalf, Collaborating as a Team), Acknowledging Boundaries (The School’s Role, “I’m Not a Counsellor,” Parents Finding Balance in Their Role), Challenges to Providing Mental Health Support (Systemic Barriers, Limitations to IEPs and Accommodations, Impact of Increasing Mental Health Needs in the Classroom, Mental Health Education Lacks Meaning, Meeting the Needs of Parents ). Bronfenbrenner’s Ecological Systems Theory was applied as an iv organizational framework to demonstrate the multilayered context in which the school provides mental health support to students. Findings highlight the many systemic and school-specific successes and challenges encountered in supporting students experiencing mental health challenges. Practical implications and directions for future research are discussed in the context of study findings. v Lay Summary The purpose of this case study was to explore and understand how a high school in the Lower Mainland of British Columbia supports students’ mental health, including those who are experiencing mental health difficulties. School observations and twenty-two interviews with members of the school community including students, parents, teachers, educational assistants, a youth engagement worker, school administrators, as well as school counsellors and a school psychologist were completed to explore student mental health support within this school. Interview analysis identified five themes and 16 subthemes. The five themes included Supportive Psychosocial Climate, Availability of Supports, Approaches to Support, Acknowledging Boundaries, and Challenges to Providing Mental Health Support. The findings are discussed within the school’s environmental context and emphasize the school’s successes, as well as the challenges involved in supporting students with mental health challenges. vi Preface This dissertation is the original and unpublished work of Alexandra Ruddy under the supervision of Dr. Laurie Ford, and Dr. G. Thomas Schanding, Jr., and Dr. Janet Jamieson served as members of the supervisory committee and provided guidance throughout the research study. Alexandra Ruddy was responsible for each phase of the research study including participant recruitment, data collection and analysis, as well as writing. Four graduate research assistants contributed to interview transcription and the researcher also consulted and collaborated with a fellow doctoral student about data analysis. Chat GPT was used occasionally to check for clarity and conciseness in writing. Ethics approval for this research study was granted by the Behavioural Research Ethics Board (BREB) at the University of British Columbia (certificate number: H21-02470). vii Table of Contents Abstract ........................................................................................................................................... ii Lay Summary .................................................................................................................................. v Preface ............................................................................................................................................ vi Table of Contents .......................................................................................................................... vii List of Tables ................................................................................................................................. xi List of Figures ............................................................................................................................... xii List of Abbreviations ................................................................................................................... xiii Acknowledgements ...................................................................................................................... xiv Chapter 1: Introduction ................................................................................................................... 1 Overview ..................................................................................................................................... 1 Researcher’s Positionality ........................................................................................................... 5 Statement of the Problem and Rationale for the Study ............................................................. 10 Definition of Key Terms ........................................................................................................... 11 Chapter Summary ..................................................................................................................... 12 Chapter 2: Review of the Literature .............................................................................................. 13 Overview ................................................................................................................................... 13 Adolescent Mental Health in Canada and British Columbia .................................................... 13 Adolescent Mental Health and its Impact on School Functioning ........................................... 16 The Role of Schools in Supporting Student Mental Health ...................................................... 19 Application of Bronfenbrenner’s Ecological Systems Theory as a Sensitizing Lens .............. 20 The Role of School Climate in Supporting Student Mental Health and Well-Being ............... 22 Home-School Collaboration ..................................................................................................... 25 Provincial Policies and Guidelines for Supporting Students with Mental Health Needs in BC Schools ...................................................................................................................................... 27 Identification As a Student with Special Needs .................................................................... 27 Provincial Initiatives and Strategies Supporting School-Based Mental Health ........................ 30 Barriers and Challenges in School-Based Mental Health Support ........................................... 32 Overview ............................................................................................................................... 32 Stigma ................................................................................................................................... 32 Perceptions of Professional Mental Health Support ............................................................. 33 Systemic Barriers .................................................................................................................. 35 Stakeholder Perspectives on Mental Health Support ................................................................ 36 viii Student Perceptions of School Mental Health Support ......................................................... 36 Parent Involvement in Their Child’s Mental Health Support ............................................... 39 Teachers’ Role and Perceptions of Mental Health Support for Students ............................. 40 Perceptions of School Administrators of Mental Health Support for Students .................... 45 Chapter Summary ..................................................................................................................... 47 Chapter 3: Methodology ............................................................................................................... 48 Overview ................................................................................................................................... 48 Purpose and Research Question ................................................................................................ 48 Epistemological and Methodological Framework .................................................................... 48 Goal and Purpose of Case Study Methodology ........................................................................ 50 Case Study Design .................................................................................................................... 50 Overview ............................................................................................................................... 50 The Case and Its Boundaries ................................................................................................. 52 Data Collection Procedures ....................................................................................................... 53 Participant Recruitment ........................................................................................................ 53 Participants ............................................................................................................................ 56 Sources of Data ..................................................................................................................... 65 Overview ............................................................................................................................... 65 Background Questionnaire .................................................................................................... 65 Individual Semi-structured Interviews .................................................................................. 66 Observations ......................................................................................................................... 67 Document Review ................................................................................................................. 69 Reflexive Journal .................................................................................................................. 71 Ethical Considerations .............................................................................................................. 72 Data Analysis ............................................................................................................................ 74 Research Quality ....................................................................................................................... 81 Chapter Summary ..................................................................................................................... 88 Chapter 4: Context ........................................................................................................................ 90 Overview ................................................................................................................................... 90 Microsystem and Mesosystem .................................................................................................. 91 Overview ............................................................................................................................... 91 School-Based Context ........................................................................................................... 92 The Exosystem .......................................................................................................................... 95 Overview ............................................................................................................................... 95 ix School District ...................................................................................................................... 95 Local Community Agencies ................................................................................................. 98 Provincial Context ................................................................................................................ 99 Federal Context ................................................................................................................... 101 Macrosystem ........................................................................................................................... 102 Chronosystem ......................................................................................................................... 103 Chapter Summary ................................................................................................................... 104 Chapter 5: Findings ..................................................................................................................... 106 Overview ................................................................................................................................. 106 Study Themes and Subthemes ................................................................................................ 108 Theme 1: Supportive Psychosocial Climate ....................................................................... 108 Theme 2: Availability of Supports ...................................................................................... 115 Theme 3: Approaches to Support ....................................................................................... 124 Theme 4: Acknowledging Boundaries ................................................................................ 133 Theme 5: Challenges to Providing Mental Health Support ................................................ 138 Chapter Summary ................................................................................................................... 151 Chapter Six: Discussion .............................................................................................................. 152 Overview ................................................................................................................................. 152 Discussion of Findings in the Context of the Literature ......................................................... 153 Supportive Social Climates and Relationships with Adults ............................................... 153 The Importance of Educator Mental Health Literacy ......................................................... 155 Pathways as a Successful Program Within an Inclusive Education Model ........................ 157 Acknowledging Boundaries ................................................................................................ 160 School-Based Mental Health Delivery ............................................................................... 162 The Impact of Systemic Barriers. ................................................................................... 162 School-Based Mental Health Delivery Models. ............................................................. 165 The Limitations of IEPs and Accommodations .................................................................. 169 The Challenge of Making Mental Health Literacy Meaningful for Students ..................... 175 Implications for School Psychologists .................................................................................... 177 Limitations and Strengths of the Present Study ...................................................................... 179 Limitations .......................................................................................................................... 179 Strengths and Contributions ................................................................................................ 181 Considerations for Future Research ........................................................................................ 184 Final Reflection ....................................................................................................................... 185 x Concluding Remarks ............................................................................................................... 186 References ................................................................................................................................... 188 Appendix A: Letters of Information ........................................................................................... 239 Appendix B: Letters for Initial Contact ...................................................................................... 243 Appendix C: Letter for Parents ................................................................................................... 251 Appendix D: Consent Forms ...................................................................................................... 254 Appendix E: Student Assent Form ............................................................................................. 283 Appendix F: Background Questionnaires ................................................................................... 288 Appendix G: Interview Questions .............................................................................................. 291 Appendix H: Mental Health Resource Lists ............................................................................... 321 xi List of Tables Table 1: Student and Parent Participant Characteristics ............................................................... 59 Table 2: School Personnel Participant Characteristics ................................................................. 62 xii List of Figures Figure 1: Embedded Single Case Study Design ........................................................................... 51 Figure 2: Themes Identified Through Data Analysis ................................................................. 107 xiii List of Abbreviations BC British Columbia BC AHS British Columbia Adolescent Health Survey CYMH Child and Youth Mental Health EA Educational Assistant ESBRT Extended School-Based Resource Team ICY Integrated Child and Youth IEP Individual Education Plan MHiS Mental Health in Schools (Strategy) PE Physical Education SBHC School-Based Health Centre SBRT School-Based Resource Team TA Thematic Analysis UDL Universal Design of Learning xiv Acknowledgements This dissertation is the result of the support, generosity, and collaboration of many individuals, to whom I am deeply grateful. I would like to begin by sincerely thanking the school that served as the site of this case study. I am especially appreciative of the administrators, school staff, parents, and students who gave their time and shared their experiences - your insights formed the foundation of this work. Without their willingness to participate and their openness to this research, this study would not have been possible. I am deeply thankful to my research supervisor, Dr. Laurie Ford, for your steady guidance, thoughtful feedback, and consistent encouragement throughout my graduate studies. I would also like to express my appreciation to my committee members, Dr. Janet Jamieson and Dr. G. Thomas Schanding, for their valued contributions and insightful feedback, all of which played an important role in shaping and strengthening this dissertation. Additionally, thank you to the graduate students who helped me transcribe my interviews. Finally, I would like to express my heartfelt thanks to my friends, colleagues, and family for their unwavering support throughout this journey. Your encouragement, understanding, and steady presence made such a meaningful difference during both the challenging and rewarding moments of this process. I truly appreciate the many ways you supported me along the way and could not have done this without you. 1 Chapter 1: Introduction Overview Mental illness will affect one in seven youth worldwide (World Health Organization, 2024). Across high-income countries, including Canada, the overall prevalence of any mental illness in children 4 to 18 years old is 12.7% (Barican et al., 2022). The deteriorating status of mental health among young people is a crisis across the globe and the mental health of Canadian youth is no exception (Wiens et al., 2020). According to the Canadian Survey on Disability (2023), 68% of youth between the ages of 15 and 24 years reported having mental health-related disabilities, the most commonly reported disability among this age group, and which reflected an 8% increase from 2017. In British Columbia (BC) specifically, around 95,000 children and youth between the ages of 4 and 18 years will experience a mental illness at any given time (Barican et al., 2022; Schwart et al., 2022) yet less than 20% receive appropriate treatment (Mental Health Commission of Canada, 2017). Without the appropriate treatment and support, mental health challenges can lead to serious consequences including difficulties with social functioning, drug and alcohol abuse, school dropout, academic failure, and suicide (Bhatia & Bhatia, 2007; Duschesne et al., 2008; Kessler et al., 1995; Rickwood et al., 2005; Riglin et al., 2014). The impact and stress of the COVID-19 pandemic only further contributed to the declining mental health of British Columbian youth (Maloney et al., 2023). In fact, compared to any other age group, young people between the ages of 15-24 reported experiencing the poorest mental health during the pandemic (Mental Health Commission of Canada, 2020). It is clear that Canadian youth are struggling with their mental health and are in critical need of support, which was the case even before the onset of the COVID-19 pandemic (Smith et al., 2019; Wiens et al., 2020). 2 Schools have become one of the primary environments in which the importance of mental health can be promoted, where students can learn about mental health and illness through curriculums aimed at improving students’ mental health literacy, and where those struggling with mental health challenges can receive support. Given the number of adolescents who experience mental health difficulties and the vulnerability of this population (Canadian Mental Health Association, 2014; Waddell et al., 2013), it is crucial that schools reflect an understanding and sensitivity towards student mental health and that schools are able to effectively address and support students’ mental health and related needs. In addition to providing access to specific school-based mental health supports, such as a school counsellor or school psychologist, schools can cultivate a non-stigmatizing environment that is supportive and accommodating for all students and that fosters engagement and connection. For students with mental health difficulties in particular, a school climate that promotes feelings of connectedness to the school and supportive and trusting relationships with teachers and peers is also extremely important (Gage et al., 2021; Marsh et al., 2019). In recognizing the different levels at which schools can play an important role in the promotion of mental health for students, BC developed the Mental Health in Schools (MHiS) Strategy (BC Ministry of Education, 2020), a whole-school system that aims to promote positive mental health within all aspects of the education system. In addition to the MHiS Strategy, the province also recognizes the school’s responsibility to support students with special needs, including those with mental health concerns through the Ministry of Education Special Education Services Manual of Policies, Procedures, and Guidelines (2016), which outlines the policies and practices that schools are required to follow, as well as their role and responsibilities to ensure that special education services are provided to students who require them. As data for the current study was collected during the 2022-2023 3 school year, the previous version of the Special Education Services Manual (2016), the manual in place for schools at the time, is referenced throughout this document, including the language therein. The Ministry of Education and Child Care updated the manual in 2024 to reflect more contemporary terminology (Government of British Columbia, 2025b) and is now titled Inclusive Education Services: A Manual of Policies, Procedures and Guidelines. While these documents are intended to ensure that schools are creating inclusive environments and providing appropriate supports to students, there is little knowledge regarding how these policies, guidelines, and strategies translate into practice within British Columbian secondary schools from the perspective of those who are required to provide and receive these supports. Furthermore, and more generally, there are few Canadian studies that examine how secondary schools specifically support students with mental health difficulties. In addition to the policies, procedures, and guidelines outlined in the BC Ministry of Education Special Education Services Manual (2016), there are a number of ways in which students’ mental health can be supported at school at the individual, classroom, school, and even school district level. However, for these support services to be appropriate and meaningful, the voices of key stakeholders within a school community, especially students, need to be heard to determine to what extent these supports are effective and to what extent students’ needs are being met. While student perspectives are critical, it is also essential to capture the perspectives of other individuals within the school community who are involved in the support provided to students including peers, parents, teachers, educational assistants, youth engagement workers, school-based mental health professionals, and school administrators. Each of these stakeholders is involved in some way, whether through the provision of direct support (at home and/or in the school) or through their contribution to the overall school climate. Peers, parents, teachers, 4 educational assistants, youth engagement workers, school-based mental health professionals, and school administrators each have a unique role in the support they provide to students, and each perspective was valuable towards developing a comprehensive understanding of the support that is received at their school. There is an abundance of literature, particularly in the United States, regarding school-based mental health. However, Canadian studies that specifically focus on school-based mental health support for students, with a particular focus on students experiencing mental health concerns, are limited, including studies that capture the voices of the multiple people that are involved in and responsible for providing support to these students. In order to capture the perspectives of key stakeholders and to create a more complete picture of how a secondary school supports its students’ mental health than currently exists, including those with identified mental health challenges, a qualitative case study was the ideal methodology. A fundamental aspect of a case study is the context in which the case is situated. A secondary school operates within a dynamic and integrated ecological system that involves, at a local level, the school, home, and school district. Beyond the school district, the school is impacted by policies and strategies developed by the province, as well as the widespread climate of mental health beyond the province in which it is located. Each of these layers within the system has significant implications for the support the secondary school is able to provide its students. Using Bronfenbrenner’s Ecological Systems Theory (1979, 1994) as an organizational framework, the complex and multi-layered nature of school mental health support for a particular secondary school, which provides the necessary and meaningful context for the case, is outlined. Through the in-depth study of a secondary school in the Lower Mainland of BC, the aim of this study was to contribute to the existing literature by including the perspectives of multiple individuals who provide and receive school-based mental health support in order to develop a 5 better understanding of this phenomenon. With its emphasis on context and the complex system in which the secondary school is situated, a case study allowed for a well-rounded and in-depth exploration and understanding of the ways in which a secondary school provides support, through its practices and overall climate for students’ mental health, particularly students with mental health concerns. Researcher’s Positionality Researchers cannot be separated from the world they are studying (Hammersley & Atkinson, 1995; Malterud, 2001); they play an active role at each stage of the research process. As the researcher, it was important to take a reflexive approach in order to acknowledge and disclose my positionality and its potential impact on the research process (Holmes, 2020). Reflexivity has been considered a significant component of conducting ethical research (Holmes, 2020; Sultana, 2007), and is a critical tool used within my selected data analysis method, reflexive thematic analysis (Braun & Clarke, 2022). My positionality includes my worldview, which is influenced by my values and beliefs, as well as my personal experiences, which are shaped by my various social identities (e.g., gender, sexuality, social class, race, ethnicity, ability status, religion, etc.; Sikes, 2004). Each individual has their own unique positionality that is not fixed, but that changes depending on the context (Holmes, 2020). Engaging in reflexivity does not eliminate bias or subjectivity from the research process, nor does it necessarily ensure good or ethical research (Delamont, 2018); however, it enables the researcher to become more aware of their potential biases and how to address them. I am a Canadian-born, White graduate student who was born female and I identify as a cisgender woman. As a graduate student completing my doctoral degree, I have a high level of education. I also do not live with a disability, including a diagnosed mental illness, which I 6 believe is important to disclose given the topic of this research project. As the researcher, it is important to reflect and to develop a conscious awareness of and a deeper knowledge of the variables that are salient in my own social identity and how those might interact with my research and the participants involved. Becoming more aware and knowledgeable about my own social identities also allows me to become more aware of my own biases, assumptions, and attitudes I have developed. With a heightened awareness and through reflexivity, I can become better at acknowledging and addressing the ways in which my own values, experiences, and social locations impact the research process. Since completing my undergraduate degree, I have had a keen interest in learning more about mental health, which has also been impacted by personal experiences with close friends and family members coping with mental illness. Throughout my studies I have focused my interest on wanting to learn more about adolescent mental health and the ways to support this group of students who are a potentially vulnerable population. I have had several opportunities working with youth in both private, community, and school settings. Working in schools has provided valuable insight into how mental health is and can be addressed and supported in this setting. Together, my past research and professional experiences have led me to develop a passion for school-based mental health. My relevant past experiences, academic, research, professional, and personal, have informed and shaped my perceptions of youth mental health in schools, as well as my approach towards the current research. For this research project, it was important to disclose my lens from within the school system. I have a Master’s degree in School and Applied Child Psychology and I am currently working towards my doctoral degree within the same program. My training and recent experience in schools has largely been as a school psychologist, which tends to be an 7 itinerant position, spending time in different schools, rather than a single school throughout a school year. While I have previous experience in schools in different capacities, my dominant lens and approach to the current research will be from that as a school psychologist, which is much different from that of an educator, administrator, or even a school counsellor. Therefore, in collecting data throughout this case study, the perspective with which I may most closely relate is the school psychologist. Other than having had been a high school student in the past (and not within the Lower Mainland of BC), I have not had the experience of being a student who requires support at school for a mental illness, nor am I the parent of a child who requires this support. I am also not an educator, nor am I a school administrator. As a result, I do not have a thorough and clear understanding of what it means and what it looks like in these roles to provide support to students with mental health concerns, including the complexities and nuances, as well as the barriers that prevent the implementation of supports. Another important disclosure that may impact my approach to this research study was my practicum placement at the alternate education high school within the school district where the study was conducted. The high school offers a continuum of social, emotional, and behavioural supports for students with diverse needs, and for many of whom have become disengaged with traditional schooling, in part, as a result of mental health challenges. This school offers a unique model to supporting these students. My experience at this school, which involved providing counselling and completing assessments with students, allowed me to see the extent to which students could be supported within the school context, which I think affected my perceptions, ideas, and expectations of what a non-alternate education school provided to students. As I progressed through the data collection of this study, I learned and better understood that not only 8 does every high school have the capacity to provide such a range of supports, but more importantly, it is not necessary for every school to provide the same range of supports. In addition to my previous roles within schools, typically as a school psychologist, I also have previous and current experience in positions within community mental health settings in which I often collaborate with schools to support my clients. In these positions, I have seen varying levels of support and effort put forth to support students across schools. Both the positive and negative experiences have certainly shaped my expectations and biases upon starting this study, having had no prior knowledge about this school. At the same time and as a result of my experience working within and with schools, I understand the challenges within schools that limit support and have compassion for those working in schools who face these barriers despite wanting to help students and families. Additionally, working as a psychology resident and mental health clinician within a government community mental health agency that faces similar barriers as schools to providing services to youth, I also needed to recognize how my own biases that stemmed from frustrations with these barriers shaped my expectations, interpretations, and conclusions. Given my academic background and past and current experiences, it is important to keep in mind my particular position as someone who is educated about mental health and illnesses, as well as my specific background knowledge I have acquired through my training as a psychologist. Furthermore, through my training as a psychologist and personal experiences, I have developed an openness about talking about mental illness as well as a belief that the more individuals communicate and share information and experiences about mental illness, the less stigmatizing it will be. By acknowledging this, I was more sensitive to my position as the researcher in speaking with the participants in my case study, as well as more aware of my 9 perceptions around the topic and what has shaped those perceptions, as well as my own biases. It was particularly important to be mindful that those who I would be working with during the study would possess varying levels of knowledge and understanding of mental health and illness and to be patient and nonjudgmental with participants. In addition, it was vital for me to approach my interviews with participants with the understanding that despite the progress that has been made within our society, there continue to be very stigmatizing beliefs and attitudes towards mental illness and it is a very sensitive topic about which not everyone, particularly youth, are open to sharing their personal experiences. Given the sensitivity of the topic, I tried to build rapport to make participants feel comfortable during interviews. I validated their emotions and experiences, I was thoughtful in my wording of questions, and I communicated that they could share what they felt comfortable sharing. I approached each interview with curiosity and an open mind to learn about the perceptions and experiences of each participant. Furthermore, I was cognizant of the potentially perceived power dynamic between myself, as the researcher, and participants. I was aware that I could be perceived as an outsider trying to criticize and determine all of things that the school was doing wrong when supporting students with mental health concerns. While this may have been my own bias or misinterpretation, I still felt it was important to clearly communicate to participants my intentions and goals for this study and to assure them that it was exploratory. Although the data were being gathered primarily for my research project, the findings were also meant to help the school gain a better understanding of how they supported students. In approaching this case study, a particular bias and belief that I initially shared was that I had a somewhat negative view of how students with mental health difficulties were supported in high school, particularly at schools that did not specifically support students with mental health 10 diagnoses or designations. In particular, I have questioned the effectiveness and usefulness of Individual Education Plans (IEPs) for students identified as having mental health challenges. This perspective was shaped, in part, from existing research on the topic, some of which is outlined in the literature review, as well as past academic and professional experiences working with and in schools. Given this disclosure as well as my positionality within the research, it was my intention to approach this case study with an optimistic and open mind. I used my reflexive journal to initially and continuously reflect on my perceptions, biases, and expectations so as not to allow this bias to overshadow my data collection and interpretation. Statement of the Problem and Rationale for the Study In BC, student-reported mental health is worsening and having a significant impact on students’ functioning at school (Smith et al., 2024). Despite the high prevalence of students identified as having mental health needs and the increasingly important role of schools to provide mental health support, little is known regarding the perceptions and experiences of school-based mental health support from key stakeholders in Canadian secondary school communities, including students, parents, teachers, and administrators (Greif Green et al., 2017). With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs, but that are also within the capacity and resources of the school. With increasingly greater pressure from the province for schools to support student mental health, it is important to understand how these policies and strategies realistically translate to the school level and how the increase in mental health concerns among students have potentially impacted teaching practices and school climate, and vice versa. Perceptions and experiences from various stakeholders collected through a qualitative case study research design provided a holistic understanding of the achievements and challenges of a 11 Canadian secondary school to meet the needs of students struggling with their mental health, an apparent gap in the Canadian school-based mental health literature. Definition of Key Terms Mental Health For the purpose of this study, mental health refers to one’s psychological and emotional well-being. Mental Health Difficulties/Challenges/Concerns Mental health difficulties/challenges/concerns refer to emotional, psychological, and behavioural difficulties that are impacting one’s functioning, particularly at school (for the purpose of this study). Mental health challenges can be a diagnosed mental illness and/or can refer to subclinical challenges/symptoms. School-Based Mental Health Support School-based mental health support involves the school’s practices towards supporting student mental health and the school’s climate. School Practices in Supporting Student Mental Health Practices refer to the behaviours and attitudes of those attending and working at the school, as well as the processes in place outlined by the Ministry of Education Special Education Services Manual (2016; e.g., the creation of an Individual Education Plan, school-based meetings aimed at providing support for students, etc.) to support student mental health (Carter, 2014). School Climate School climate refers to, “the norms, expectations, and beliefs that contribute to creating a psychosocial environment that determines the extent to which people feel physically, emotionally, and socially safe” (Aldridge & McChesney, 2018, p. 122). 12 Secondary School Student For the purpose of this study, secondary school student refers to students in Grades 8-12. Chapter Summary A significant number of youth in BC are struggling with their mental health and schools have become primary environments in which to promote positive mental health, address mental health literacy, and access mental health support. This case study explored how a secondary school in BC supported students’ mental health by gathering insights from students, parents, and school staff. Using Bronfenbrenner’s Ecological Systems Theory (1979, 1994), the research examined the school’s provision of support through its practices and climate and the impact of broader systems on this support. The study provided further insight and a deeper understanding of the challenges and successes of the implementation of school-based mental health support in one secondary school within the Canadian context. 13 Chapter 2: Review of the Literature Overview The purpose of this chapter is to provide a review of the relevant existing literature surrounding school-based mental health support for students, with a particular focus on students experiencing mental health concerns. In this chapter, the current state of adolescent mental health in Canada and BC is described, as well as how the COVID-19 pandemic has impacted the mental health of young Canadians. Bronfenbrenner’s ecological systems theory (1979, 1994) is applied to the current case study in order to provide a better understanding of the contextual factors that influence school-based mental health support for students. The role of the school, including its school climate, in supporting the mental health needs of students is discussed, as is the importance of home-school collaboration. Next, I provide a review of the BC policies and guidelines, as well as provincial strategies and initiatives that are intended to support students with special needs, particularly those with mental health challenges. Finally, this chapter includes a brief review of the literature surrounding student, parent, teacher, and school administrators’ perspectives regarding school-based mental health support. Adolescent Mental Health in Canada and British Columbia Within Canada, 10% to 20% of youth may experience significant mental health challenges (Canadian Institute for Health Information, 2019), which can be referred broadly “as experiences of emotional or psychological distress that affect daily functioning” (DeFosset et al., 2017, p. 1191). Most mental disorders initially manifest in adolescence or young adulthood (Kessler et al., 2005). Internalizing disorders, which include mood and anxiety disorders, are among the most common mental health problems in Canadian youth, and the rates of diagnosis have increased over time. Between 2011 and 2018, the prevalence of diagnosed mood and 14 anxiety disorders in youth between the ages of 12 and 24 years increased from 4.3% and 6.0% to 7.8% and 12.9%, respectively (Wiens et al., 2020). Most alarming is that suicide is the second leading cause of death among 15-24-year-olds in Canada (Public Health Agency of Canada, 2025). Every five years, the BC Adolescent Health Survey (BC AHS; Smith et al., 2024) is administered to adolescents between the ages of 12 and 19 years across the province. According to the most recent 2023 BC AHS (Smith et al., 2024), which was completed by 38,488 students across 59 school districts in BC, 38% of students rated their mental health as “good,” 29% of students rated their mental health as “fair” and 12% rated their mental health as “poor.” Sadly, researchers observed a decrease in positive mental health amongst youth over the past decade. Furthermore, older students were more likely to rate their mental health poorly compared to younger students. Compared to 2018 results, 2023 findings indicated an increase in students reporting some mental health conditions including anxiety. There was a decrease, however, in students who reported experiencing depression. It is also significant that 18% of students indicated suicidal ideation in the past year, an increase from 2013 and 2018 findings. The percentage of youth who attempted suicide in the past 12 months also increased slightly since 2018. Overall, these findings suggest that while most young people between 12- and 19-years-old in BC consider themselves to have good mental health, the prevalence of self-reported mental health challenges is increasing (except for depression). The general worsening of youth mental health between 2018 and 2023 may be attributed, in part, to the COVID-19 pandemic. Given the number of significant stressors associated with the pandemic, it is no surprise that young people experienced mental health challenges, including anxiety and depression (Cost et al., 2021). The Mental Health Commission of Canada (2020) 15 administered a COVID-19 Survey to examine the experiences of Canadian youth during the pandemic. Specifically, survey questions inquired about challenges they faced, coping strategies, help-seeking behaviours they engaged in to support their mental health, as well as positive experiences they encountered during the pandemic. Respondents included 137 Canadian youth between the ages of 12 and 24 years located in Quebec, Ontario, Saskatchewan, Alberta, and BC. Survey findings, which are described in the report titled, Lockdown Life: Mental Health Impacts of COVID-19 on Youth in Canada (Mental Health Commission of Canada, 2020), indicated that youth mental health was significantly impacted by increased stress associated with extended social isolation, closure of schools and organized activities, and limited access to mental health supports. Youth between the ages of 15-24 were at higher risk of experiencing poor mental health during the pandemic compared to other age groups, and marginalized youth, including young refugees, youth living in rural areas, Indigenous youth, racialized and ethnic minority youth, young persons with disabilities, and young people of diverse sexual orientations and gender identities, as well as youth who had existing mental health challenges, fared much worse. Further, youth with pre-existing mental illness experienced further deterioration in their mental health (Cost et al., 2021). During the pandemic, young people also found themselves in crisis. Suicide attempts and suicide-related calls to distress centres had increased in different parts of the country (Brown, 2021; Krugel, 2020). Additionally, the CAMH study (2020) found that 18% of all respondents had suicidal thoughts in the early stages of the pandemic. Data collected throughout the pandemic also demonstrated the worsening mental health of youth in BC (Samji et al., 2022). Findings from a BC Children’s Hospital project (Samji et al., 2022) which drew on BC-based data sources, including the Personal Impacts of COVID Survey (PICS) and the Youth Development Instrument (YDI), indicated risk and protective factors that 16 impacted youth mental health throughout the pandemic. In particular, loneliness, school pressure, and sleep difficulties were correlated with worse mental health. On the other hand, good sleep habits, support from adults and peers, optimism, emotion regulation, self-esteem, and school-related factors including school climate, safety and belonging were associated with more positive mental health. Data for the present study was collected during the 2022-2023 school year. Although at this point in time, the day-to-day of secondary schools had generally resumed to what it once looked like before the pandemic, the toll of the pandemic on adolescent mental health had become evident, according to the literature. Given the timing of the present study, the occurrence and impact of the COVID-19 pandemic provides significant contextual information that may have impacted the need for and provision of mental health supports for students. Adolescent Mental Health and its Impact on School Functioning Mental health challenges can have a significant impact on an adolescent’s life that have long-term negative effects (Schlack et al., 2021). Of particular importance in the school setting is the significant impact of mental health challenges on the student’s academic success and social functioning (Chan et al., 2008; Kessler et al., 1995; Pate et al., 2017; Schulte-Körne, 2016). In particular, internalizing problems have been found to negatively impact school outcomes for children and adolescents (Riglin et al., 2014). Students who experience mental health challenges have significant adjustment problems in high school, including poorer attendance, greater difficulty with academic work, and worse performance in key academic skill areas including reading, writing, and math (DeSocio & Hootman, 2004; Farmer et al., 2011; Nelson et al., 2004). These students have higher rates of being absent and tardy (Gall et al., 2000), are at a greater risk of dropping out of school (Duschesne et al., 2008; Fergusson & Woodward, 2002), and of not 17 continuing their education following high school (Farmer et al., 2011). For example, Patalay and colleagues (2015) investigated the relationship between internalizing symptoms and academic attainment across three consecutive years in early adolescence. The longitudinal study, which took place in England involved 2,647 participants between the ages of 11-14 years. Academic attainment was measured by scores obtained from national standardized tests that assessed skills in English, Math, and Science and were taken when participants were ages 11 and 14 years of age. Internalizing symptoms were assessed in the fall of each school year for three years. Compared to peers with low levels of internalizing symptoms at each time point, the authors found that increasing internalizing symptom trajectories predicted significantly worse academic outcomes. In addition to poorer academic grades, students with internalizing symptoms were also at risk of dropping out of school all together. In another longitudinal study consisting of eight waves of data involving 1,057 Australian adolescents, Butterworth and Leach (2017) investigated the association between the early experience of a distress disorder (i.e., symptoms of anxiety and/or depression) and subsequent school dropout. Results indicated that adolescents experiencing symptoms of anxiety or depression were two times more likely to drop out of high school compared to peers who did not have a previous distress disorder. For students across BC, the impact of mental health challenges on school functioning was evident, according to the results from the 2023 BC AHS, described above. While 13% of students reported missing at least one day of school in the past month due to mental health challenges such as depression or anxiety, 8% of students reported missing three or more days in the past month (Smith et al., 2024), the latter of which was an increase from 2018 findings (Smith et al., 2019). Furthermore, mental health challenges such as anxiety and depression prevented 17% of students from participating in sports or extracurricular activities in the past year (Smith et al., 2024), which was 18 another increase from the 2018 BC AHS. These findings demonstrate the worsening impact of self-reported mental health challenges on student functioning. The onset of and ongoing mental health challenges can lead to subsequent negative school experiences, and vice versa. Studies have demonstrated how initial internalizing symptoms could impact one’s ability to do well in school (Chen et al., 1995; Flook et al., 2005; Roeser et al., 2000). For example, symptoms of anxiety and depression could impact cognitive functioning, and thus impact academic performance (Maughan et al., 2003). Symptoms may also interfere with making new friends, with the motivation to succeed or do well in school, or with one’s ability to focus and concentrate to learn and retain class content (Roeser et al., 2001). On the other hand, longitudinal studies have shown that difficulties in academic and social functioning lead to later internalizing symptoms (Burt et al., 2008; Chen et al., 2000; Herman et al., 2007; Masten et al., 2005; Obradović, et al., 2010). Having challenges at school early on, both academically and socially, could be frustrating, isolating, and difficult to cope with in the absence of appropriate support, and understandably lead to the development of anxiety and depression. A systematic review examining this bidirectional relationship between internalizing and externalizing disorders and school dropout found that while disruptive behaviour disorders and substance use had more of a direct effect on school dropout compared to internalizing disorders, mood and anxiety disorders developed as a consequence of school dropout (Esch et al., 2014). In BC, the completion and graduation rates of students with disabilities tend to be lower than all students with and without disabilities. According to 2023-2024 statistics, 78% of students with disabilities and diverse abilities, which include students identified as having a mental illness, graduated in Grade 12 compared to 91% of all students (BC Ministry of Education and Child Care, 2024). Within the population of BC students identified as having 19 special needs in 2019, students identified as requiring intensive behaviour interventions or a serious mental illness (Category H within the Ministry of Education designations) had the lowest high school completion rate (58%) of any other special education category (Lloyd & Baumbusch, 2019). Overall, students with mental health difficulties can encounter many challenges at school that impact their success, both in the short- and long-term. Students’ mental health challenges can be a result of or contribute to academic and social difficulties. Students can also become disengaged from school and be frequently absent, further exacerbating long-term hardships. These findings documenting the unique challenges and unfavourable outcomes for these students only help to emphasize the importance of providing support for these students in schools. The Role of Schools in Supporting Student Mental Health Schools are an ideal environment in which to address the mental health needs of children and adolescents (Atkins et al., 2017). Schools that prioritize and cultivate environments that are inclusive, safe, and caring have a significant impact on the mental health of its students (Aldridge & McChesney, 2018; Denny et al., 2016; Gase et al., 2016; Kohoulat et al., 2015; Lester & Cross, 2015; McLaughlin & Clarke, 2010; Pate et al., 2017; Wang, 2009). In addition, as students’ mental health difficulties can interfere with academic growth and functioning at school, schools are in a natural position to respond to students’ mental health needs (Chan et al., 2008; Pate et al., 2017; Schulte-Körne, 2016). Integrating schools and mental health services is beneficial for youth because schools can allow for the access to a greater number of adolescents in need of mental health education and services (Mulloy & Weist, 2013; Soutter, 2011). The school environment plays a major role in the promotion of positive mental health, as well as the prevention and early intervention of mental health challenges. This is especially important given 20 the adjustment that takes place during the developmental period of adolescence. In addition, the transition from elementary to secondary school requires an adjustment for all students and may involve adverse effects for some, including declines in academic achievement (Alspaugh, 1998; Evans et al., 2018; Rice, 2001), lower self-esteem (Richardson, 2000), and more school-related stress (Rudolph et al., 2001). Secondary school differs drastically from the day-to-day and overall operations and structure of elementary school. For example, secondary schools are larger in size, students move from class to class with multiple teachers, and instruction of class content is different. Furthermore, the transition to secondary school is accompanied by a heavier workload, and social adjustments, including new and changing relationships with peers and adults within the school (Akos & Galassi, 2004; Eccles & Roeser, 2011; Longobardi et al., 2016). Attributed to the lack of fit between adolescents’ developmental needs and their learning environment in secondary school (Eccles, 2004; Eccles & Midgley, 1990; Eccles & Roeser, 2011; Ellberbrock & Kiefer, 2013), this transition from elementary to secondary school is believed to worsen students’ mental health and wellbeing (Barber & Olsen, 2004; Benner & Yang, 2014; De Wit et al., 2011; Waters et al., 2012). The transition to secondary school is accompanied by a slew of new stressors that can initiate the onset of mental health difficulties or exacerbate previously existing challenges. As a result, it is particularly important to provide students with the appropriate support during and following their transition to secondary school. Application of Bronfenbrenner’s Ecological Systems Theory as a Sensitizing Lens According to Bronfenbrenner’s ecological systems theory (1979, 1994), a child’s development is shaped and influenced by a complex and nested system of inter-related environments. These layered subsystems, which range from one’s immediate environments to the cultural norms, values, and beliefs within a society, provide important context to how an 21 individual develops. Bronfenbrenner described the ecological system in which an individual is situated as consisting of five nested and layered environments: the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. The microsystem is the innermost environment that has the most direct impact on a child’s development. It consists of the immediate environments in which a child is raised and the bidirectional relationships that develop within these settings such as parents in the home, peers, and school, the last involving a child’s relationships with school personnel. The next level, the mesosystem, involves interactions between the microsystem environments that influence the child’s development. For example, home-school collaboration and peer-family interactions. The exosystem, which involves more distant environments that have an indirect, yet significant impact on the individual’s development, includes settings such as a parent’s workplace, a school district, or the local government. The macrosystem encompasses the broader cultural, societal, and ideological influences such as overarching beliefs, values, and norms and expectations that shape an individual’s development. In addition, an individual is shaped by the social, economic, and political climate that comprises a macrosystem. Lastly, the chronosystem represents the impact of time on a child’s development, including life transitions and changes, cultural shifts, as well as historical events that take place in one’s lifetime. In this case study, Bronfenbrenner’s model (1979, 1994) was used as a framework to better understand the support that is provided to students who were struggling with mental health difficulties at the school level by demonstrating the layered contextual influences of the ecological system in which the school was situated. Although the school and the stakeholders within the school community were the primary focus of this case study (i.e., the microsystem), the school existed within an ecological system in which there were a multitude of factors beyond 22 the walls of the school building that impacted the support that was provided to students with mental health challenges. Given the importance of context within case study research design, Bronfenbrenner’s work (1979, 1994) provided a useful organizational framework in which to explain and understand the complex multi-layered nature of school mental health support. In the current case study that explored the support that is provided to students with mental health difficulties within a secondary school, each subsystem within Bronfenbrenner’s model played a critical role in shaping how student mental health is addressed, promoted, and supported in BC schools. The Role of School Climate in Supporting Student Mental Health and Well-Being School climate can be defined as “the norms, expectations, and beliefs that contribute to creating a psychosocial environment that determines the extent to which people feel physically, emotionally, and socially safe” (Aldridge & McChesney, 2018, p. 122). As school climate refers to a collective experience by multiple people within the school, a whole school approach that involves all members of the school community needs to be taken in order to create a positive school environment (Cohen et al., 2009; Ontario Ministry of Education, 2013). A school’s climate has major implications for students within the school, as it not only influences adolescents’ experiences and self-perceptions while they are there but has the potential to influence their life courses (Baker et al., 2003). Although inconsistently defined within the literature, researchers agree that school climate is a multidimensional construct that has significant implications for student mental health and well-being (Aldridge & McChesney, 2018). Previous research has demonstrated several school climate domains that are related to adolescents’ mental health including students’ connection to school and their sense of belonging, relationships with teachers and peers, school 23 safety, and academic environment (Aldridge & McChesney, 2018; Denny et al., 2016; Gase et al., 2016; Kohoulat et al., 2015; Lester & Cross, 2015; McLaughlin & Clarke, 2010; Pate et al., 2017; Wang, 2009). With regards to support within the school environment, the concept of school connectedness is an important factor for positive school- and mental health-related outcomes. School connectedness refers to “the extent that students feel staff and peers in their academic environment care about them as individuals, their academic success, and their overall wellbeing” (Marsh, 2018, p. 68). Feeling connected to school is related to better emotional well-being (Eccles et al., 1993), higher academic achievement and higher likelihood of graduating from high school (Osterman, 2000). Students who feel connected to school are less likely to skip school and more likely to succeed academically (Connell et al., 1995; Schaps, 2005). School connectedness can have major protective implications for student mental health, particularly students’ emotional well-being. For example, Pate and colleagues (2017) explored the relationship between adolescent emotional distress, school connectedness, and academic achievement. As part of a longitudinal study, the authors collected data from 7,276 participants at two time points. Participants were between the ages of 13 and 16 years during the first wave and older adolescents or young adults during the second wave. School connectedness was found to both mediate and moderate the relationship between emotional distress and academic achievement. Adolescents who reported higher levels of emotional distress had more negative perceptions of school connectedness, and thus lower academic achievement. In terms of its moderating effect, as levels of school connectedness increased, levels of academic achievement also increased depending on students’ level of emotional distress. 24 As school connectedness can have a major impact on students’ mental health and academic performance, it is important that students feel connected to and engaged with their school. Given its significance, questions about school connectedness are typically part of the BC AHS (Smith et al., 2024). Results from the 2023 BC AHS (Smith et al., 2024) indicated that the majority of students felt like they were part of their school (54%), were happy to be there (52%), and had positive relationships with school staff. However, students’ feelings of connectedness have diminished compared to the 2018 survey results. For BC students, feelings of connectedness to school are declining, which may also lead to poorer outcomes related to mental health and academic achievement. A major component of school connectedness is the relationships that students form with the adults in their school, including teachers. It has been well-established that student-teacher relationships play a central role in students’ emotional well-being (e.g., Allen et al., 2018; Murray-Harvey, 2010; Reddy et al., 2003; Suldo et al., 2009). For students identified with special needs, particularly those with mental health concerns, the significance of this relationship is paramount towards a more positive school experience. For example, Marsh and colleagues (2019) examined the differences in school connectedness between students with Emotion and Behavioural Disorders (EBD; 68 participants) and students in general education (68 participants). The authors created their own questionnaire to assess school connectedness. Results indicated that students with EBD generally reported lower levels of school bonding, school attachment, and school engagement than their general education peers; however, only the difference in school bonding, defined as the development of student-teacher relationships, was significant (Marsh et al., 2019). In a more recent quantitative study with a sample of more than 350,000 students in Grades 9 to 12, Gage, Kramer II, and Ellis (2021) also investigated whether 25 students with or at risk of EBDs perceived their school’s climate differently than typically developing peers. Several domains of school climate were examined including school connectedness, peer and adult social support, cultural acceptance, social learning, physical environment, and school safety. The authors found that students with or at-risk of EBDs had significantly more negative perceptions of school climate across all domains, with the greatest differences in overall school climate, school connectedness, and peer social support. Further, the researchers examined the differences in perceptions of school climate between students who had an identified EBD at school and were receiving IEP services and students who were at risk for EBD (i.e., were not receiving any additional support at school). Findings indicated that students receiving special education supports at school, including an IEP, reported more positive perceptions of their school climate, and more positive perceptions of adult support, compared to students who were at-risk of EBD. These findings suggest students with EBD who are receiving school support services, such as an IEP, may have a more positive perception of their school and may possibly feel well supported at school, particularly by the adults involved in their support. As students with mental health difficulties can have particular challenges with developing a connection to school, it is necessary for schools to take on the responsibility of ensuring that students feel connected through promoting a sense of belonging, positive relationships, and school climate. Developing their relationship to school through improving school connectedness may be an essential step to providing them with the necessary and appropriate support to succeed in the school environment. Home-School Collaboration By involving parents in the present study, there was a primary focus on the interaction between home and school; however, secondary schools nevertheless support students by 26 collaborating with community supports and agencies as well. The Ministry of Education Manual of Policies, Procedures and Guidelines for Special Education Services (2016) also recognizes the importance of parents’ roles and responsibilities in their child’s education. Parents’ knowledge and expertise about their own child are viewed as beneficial. Parents of students with special needs must be consulted about the educational placement of their child and they are meant to be involved in the planning, development, and implementation of their child’s educational program, as well as their child’s Individual Education Plan. The importance of the home-school partnership is underscored by its demonstrated benefits for students, including positive impacts on their psychosocial functioning and behaviour, academic achievement, sense of belonging, motivation and engagement with school, and attendance and retention (Arunkumar et al., 1999; Bachman et al., 2024; Capretta et al., 2024; Gonzalez-DeHass et al., 2005; Harris & Goodall, 2008; Wang & Eccles, 2012). Beyond the positive student outcomes, a supportive home-school partnership also creates a more positive school climate (Povey et al., 2016). A major component of a successful home-school partnership includes the positive working relationship between caregivers and school staff that involves a shared responsibility for the student’s learning and a mutual sharing of information and knowledge (Christenson, 2004; Raftery et al., 2012). Family-school collaboration can also provide meaningful support for student mental health and wellbeing. Identified by the authors as a newer area of research, Bachman, Cunningham, and Boone (2024) conducted a comprehensive, narrative literature review to explore the impact of family-school partnership on student mental health. They discovered several themes across the existing literature that reflected “high-impact, partnership-focused protective factors” (p.3) that support the positive mental health of children and youth. 27 The authors determined that students benefit when school personnel encourage supportive relationships at home, when families and school are supportive in building positive student-teacher relationships, when home and school create congruent rituals and routines to support students’ growing sense of identity and stability, when educators nurture students’ and families’ sense of belonging within the school community, and when family-school collaboration encourages students to solve problems and self-regulate in a range of contexts. As demonstrated by this literature review study, the working relationship that occurs between home and school can have a powerful impact on students’ mental health and wellbeing through the development of a sense of belonging and identity, their relationships with adults at school and at home, as well as their ability to problem solve and manage their emotions and behaviour. As the involvement and collaboration with caregivers is a crucial component of the support that schools provide students who are struggling with their mental health, it was imperative to include parents of students who attend the secondary school in the current study to explore how this type of collaboration takes place in this particular context. Provincial Policies and Guidelines for Supporting Students with Mental Health Needs in BC Schools Identification As a Student with Special Needs The forms of support provided to students with special needs, including mental health difficulties, are outlined by the province’s Ministry of Education Special Education Services Manual (2016). The primary types of school support services that are most relevant for students with mental health difficulties include learning assistance for students who have learning challenges, school counselling, and school psychology services. In addition, school districts may 28 also provide hospital education and homebound education services for students to continue their education programs outside of the school setting. In BC, students with identified special needs are designated into one (or two) of 12 categories set out by the Ministry of Education, two of which are specifically for students with behavioural and mental health needs: Students Requiring Intensive Behaviour Intervention or Students with Serious Mental Illness (Category H) and Students Requiring Behaviour Support or Students with Mental Illness (Category R). Category H is a funded category for students with more severe emotional and behavioural needs (BC Ministry of Education, 2016). Since the 2020/2021 school year, there has been an increase in both special education categories across the province (Government of British Columbia, 2025c). In order to be designated as a student in Category H, a student must provide documentation that includes either a behavioural assessment and/or a mental health assessment that indicates evidence of either antisocial, extremely disruptive behaviour in most environments (e.g., the classroom, school, family, and community) that is consistent over time and/or a severe mental health condition that has been diagnosed by a mental health professional (i.e., psychologist, psychiatrist, or physician). For students with a serious mental health condition who are eligible for this category, the mental illness has to manifest itself in significant withdrawal or other negative internalizing behaviours, and these students are considered “at risk” without extensive support. Additionally, to meet criteria for this category, whether that is as a student requiring behaviour intervention or with a serious mental illness, the condition must be significant enough that it is known to school and school district personnel, and requires intensive intervention by a community agency or service that is beyond the school’s capacity. That is, the condition requires intervention that goes beyond what the school is able to offer through services 29 such as school-based counselling, moderate behaviour supports, the use of alternate settings, and other means in the school environment. The condition must also be a serious risk to the student or to others and must significantly interfere with the student’s academic progress or that of other students. In order to be designated as a student in Category R, a category that does not provide additional funding for the school, the student must provide documentation that provides evidence of requiring moderate behaviour support or as having a mental illness. Students who require moderate behaviour support must demonstrate behaviours such as aggression (of a physical, emotional, or sexual nature) and/or hyperactivity and/or behaviours related to social problems (e.g., delinquency, substance abuse, child abuse or neglect). Students with a mental illness must provide documentation of a diagnosis made by a qualified mental health clinician. These students may demonstrate negative or undesirable internalized psychological states (e.g., anxiety, stress-related disorders, depression), and/or behaviours related to other disabling conditions (e.g., thought disorders or neurological or physiological conditions). In addition, to meet criteria for this category either as a student who requires moderate behaviour support or with a mental illness, their behaviours or symptoms must interfere with their functioning (academic, social, or personal). The student’s behaviour or symptoms must be present over an extended period of time, in more than one setting, and with more than one person (e.g., teacher, peers). Finally, students who meet criteria for Category R must not have responded to support provided through typical school discipline and classroom management strategies. Students identified as having special needs are provided with an IEP, a document that outlines individualized goals, including academic and social-emotional goals, and the various supports to be provided to the student, including any adaptations, modifications, services to be 30 provided, as well as measures for tracking achievement. It is recommended that the IEP is developed through a collaborative process among the student, parents, teachers, and school administration (BC Ministry of Education, 2016). While these are the requirements and IEP procedures outlined by the BC Ministry of Education Special Education Services Manual (2016) for students with special needs, including those with mental health conditions, the practical implementation of these guidelines surrounding the support for students with mental health concerns has not yet been investigated from the various perspectives of those within the school who receive and provide these support services. Furthermore, how supports and services that are provided, such as an IEP, meet the needs of students has not been studied with this population in BC. Provincial Initiatives and Strategies Supporting School-Based Mental Health In addition to the Ministry of Education Manual of Policies, Procedures and Guidelines for Special Education Services (2016), the provincial government has also developed several initiatives and strategies that address and promote positive mental and physical health, as well as target inclusive and safe school climates. These strategies and initiatives reflect the provincial government’s prioritization of student health in schools and the importance of creating healthy and safe learning environments for students. Most notably, the MHiS Strategy (2020) is a recent initiative released in September 2020 that outlines a vision of a system-wide approach to the promotion and embedding of positive mental health in all aspects of the education system, including culture, leadership, curriculum, and learning environments. This strategy is a universal intervention for all students, and it is positioned as a building block for prevention and intervention in schools. Building upon the foundation of social-emotional learning, the Strategy focuses on three main elements to promote positive mental health: Compassionate Systems 31 Leadership, Capacity Building, and Mental Health in the Classroom. Compassionate Systems Leadership focuses on the well-being of adults within the system and involves adults engaging in internal, relationship, and system work to support systems change. Capacity Building focuses on equipping schools with the appropriate tools and supports to build capacity for promoting and supporting mental health in schools. Social emotional learning, mental health literacy, and a trauma-informed approach are described as primary vehicles to promote positive mental health in schools. Finally, Mental Health in the Classroom involves integrating mental well-being and Indigenous Knowledge and Perspectives into the school setting, including having mental health resources and tools in classrooms and embedding mental well-being and Indigenous Knowledge and Perspectives throughout BC’s education curriculum. This element emphasizes the importance of relationship building to students’ learning and to creating safe learning environments. Each of the core elements within the MHiS strategy can play a key role in nurturing a supportive school climate around mental health by supporting the well-being of adults in the building, increasing mental health literacy for students and school staff, including valuable coping skills, reducing stigma, enhancing teachers’ professional development through targeted training, and promoting mental health through the integration of mental health in all aspects of student learning, not just a single class or lesson. A building block for the MHiS Strategy, expect respect and a safe education (erase; Government of British Columbia, 2025a) is another whole school approach that is intended to create safe, inclusive, and respectful school communities. A safe and accepting learning environment positively impacts students’ connection to school and sense of belonging, and thus their mental health and well-being. erase offers resources to students, adults, and school staff regarding diversity and inclusion, mental health and substance use, as well as school and online 32 safety. There is also an online function that allows students to report something that they see or hear that they feel is unsafe or to access help from a crisis resource. Similarly, taking a whole school approach, Healthy Schools BC aimed to improve students’ academic and health outcomes (Healthy Schools BC, 2015) by creating “healthy” school communities that promote students’ social, emotional, mental, and physical health through education, policies, community partnerships, and the surrounding school environment (Healthy Families BC, 2012). These provincial initiatives collectively contribute to a supportive and inclusive school environment that prioritizes student mental health and well-being within BC. Barriers and Challenges in School-Based Mental Health Support Overview Schools can face many challenges when providing direct support to students due to students’ own experiences that may interfere with help-seeking, including stigma and perceptions of mental health support. In addition, schools must contend with systemic barriers that interfere with their ability to provide sufficient and adequate support, including limited resources and high caseloads for school mental health professionals. Stigma The most commonly identified barrier to seeking mental health services is stigma (Bowers et al., 2013). Stigma refers to the negative attitudes and behaviours directed toward people with mental health challenges and can be a barrier to early identification and support due to feelings of shame and embarrassment about their mental illness (Select Standing Committee on Children and Youth, 2014). Stigma of mental health challenges still exists within the school environment (Bowers et al., 2013; Chandra & Minkovitz, 2007; Dimitropoulos et al., 2022; Gronholm et al., 2018). In a systematic review of qualitative studies that addressed stigma 33 related to school-based mental health support, Gronholm and colleagues (2018) identified that students reported anticipated and experienced stigma related to school-based mental health support, including being negatively labelled as a result of receiving mental health services, being discriminated against and bullied by peers and school staff, and being concerned about confidentiality. Stigma in the school environment also led students to be reluctant to share information and avoid engagement with services all together (Gronholm et al., 2018). Stigma towards mental health challenges is still prevalent, particularly in the school environment. Stigma is a powerful barrier for young people that can prevent the early identification of a debilitating mental illness and to receiving the necessary support. Findings from previous studies indicate that for students who have been diagnosed and who sought support for their mental health, stigma from peers and staff at school can still occur (Moses, 2010). In the current study, it will be important to discover from the perspectives of the various stakeholders how accommodating the school is for students who have been identified as struggling with their mental health. Voices from the different stakeholders will provide a complete picture in determining to what extent experiences of stigma continue to occur in the school setting. Perceptions of Professional Mental Health Support Another major component of support at school, particularly those with a Category H designation, is receiving professional help either through community mental health agencies or by the school counsellor. Adolescent perceptions of professional support, either within or outside of the school, can pose as another barrier to seeking mental health services. The existing literature reflects both the positive and negative perceptions of young people towards professional support (Armstrong et al., 2000; Corry & Leavey, 2017; Gulliver et al., 2010; Ohrt 34 et al., 2016; Rickwood et al., 2005; Rickwood et al., 2007). On the one hand, students have expressed satisfaction with their school counsellor (Ohrt et al., 2016). For example, in a qualitative study exploring adolescents’ perceptions of their school counsellor, students discussed how school counsellors prepared them for the transition after high school, provided them with many valuable life skills, as well as emotion and social support, and individual attention. In addition, students commented on the positive personal qualities of their counsellor, including how they could be trusting, encouraging, caring, and motivating, as having a positive attitude; and creating a personal connection. While these students discussed the positive attributes of their school counsellors, Gulliver and colleagues’ (2010) systematic review of the perceived barriers and facilitators to mental health help-seeking in young people found that a mental health professional’s personal attributes, such as their race, credibility, ability to provide help, familiarity, negativity, and being judgmental can actually discourage young people from seeking professional support. In schools specifically, the following characteristics of mental health support providers were identified as deterrents for students seeking help: active negativity, breach of confidentiality, dual roles (i.e., being a counsellor and authority figure), judgmental attitude or tendency to show favouritism, unhelpful responses, being completely unaware and unrealistic about adolescents’ activities, psychologically inaccessible, and too busy. Students’ relationships with the adults in their social environment, such as school, can have a major influence on their help-seeking behaviour (Pisani et al., 2012; Rickwood et al., 2007). In the current study, the perceptions and experiences from students who require this type of professional support at school may help to shed light on how school-based mental health support from the school counsellor and other school staff have met their individual needs and have impacted their overall school experience. 35 Systemic Barriers Limited resources are a commonly reported barrier that interfere with schools’ ability to provide adequate support to students struggling with mental health difficulties. Limited resources include limited staff capacity or limited specialized staff that are trained to support adolescent mental health, limited funding, lack of time within the school day, and high caseloads for school mental health professionals (Canadian Psychological Association, 2022; Carlson & Kees, 2018; Eiraldi et al., 2015; Patalay et al., 2016; Teich et al., 2008; Wiedermann et al., 2023). In a descriptive survey research study that involved 120 school counsellors, the majority of participants reported that a lack of time was a major barrier to providing the necessary supports to students due to other demands within the school setting (Carlson & Kees, 2018). In addition to directly working with students to address their mental health, school mental health professionals often have many other responsibilities including consultation, teaching, course scheduling, facilitating meetings with school and school district personnel, all of which require a significant amount of time and paperwork (Fabek et al., 2023). Furthermore, there are typically too few counsellors or school psychologists within a school or school district to be able to adequately support the number of students who may need support. For example, the current ratio of school counsellors to students in BC schools is 1:693 (BC Public School Employers’ Association & BC Teachers’ Federation, 2022). Furthermore, while the recommended psychologist to student ratio is 1:500 to 1:1000 across Canada, ratios are realistically much higher than this, making it extremely difficult for school mental health professionals to meet the needs of the student populations that they serve (Canadian Psychological Association, 2022). In a position paper of the Canadian Psychological Association (CPA; 2022), the authors highlighted the systemic challenges impacting school psychologists’ roles in meeting students’ 36 needs, including the limited understanding that exists amongst schools regarding the unique expertise and skillsets that school psychologists can offer in supporting student mental health and wellbeing. As a result of this limited understanding, the roles of school psychologists in schools are limited and under-utilized. The authors also discuss the shortage of school psychologists, particularly in rural and remote areas of the country, leading to long waitlists, lack of time, and limited access to school psychology services. Lastly, another systemic challenge plaguing the profession concerns recruitment and retention problems across Canada due to aforementioned limited resources including high caseloads, lack of time, stressful work conditions, and an inability to provide the scope of services that reflect school psychologists’ extensive training and student/school needs. The systemic barriers and challenges that impact the provision of school-based mental health services are widely experienced across the globe and have a significant impact on schools’ ability to meet the mental health needs of secondary school students (Canadian Psychological Association, 2022; Fabek et al., 2023; Patalay et al., 2016). As these challenges are seemingly universal, it is likely that they, and possibly other unique challenges and barriers at the local level will be emphasized by key stakeholders within the current case study. Stakeholder Perspectives on Mental Health Support Student Perceptions of School Mental Health Support To fully understand the extent to which secondary schools are supporting their most vulnerable students, particularly those with mental health difficulties, it is particularly important to give the students who are receiving these services a voice to describe their own perceptions and experiences. Not only can students provide a unique perspective regarding whether the support they are receiving at school is sufficient and meeting their needs, but they can also 37 provide valuable feedback that can significantly improve the support that is provided to themselves, as well as other students who may be struggling. Using Interpretative Phenomenological Analysis, Balagna, Young, and Smith (2013) interviewed 11 Latino and Latina students in the United States between the ages of 11 and 13 years who were identified as being at-risk for emotional and behaviour disorders about their school experiences. A prominent overarching theme that emerged for these students was their relationship with peers, teachers, and family members. For these students, teachers who were kind, understanding, flexible with deadlines, active, upbeat, fun, allotted one-on-one time with students, and who took a personal interest in students were perceived more favourably. On the other hand, teachers who were perceived as angry, strict, and did not understand their students were perceived less favourably. If teachers did not take in interest in them or if they felt their teacher did not like them, the students were less likely to be motivated to do well academically and more likely to not attend their class altogether. Overall, the behaviour of these students was strongly influenced by their relationship with their teachers. In addition, for those who reported that their parents were involved in their school experience, parental involvement contributed to a positive experience, particularly when parents advocated on their behalf when they had to assert their needs at school. Other students who were struggling academically and were unable to communicate this to their teachers described feeling embarrassed and humiliated. As a result, they avoided the teacher, acted out in class, or skipped class. Also, teachers did not always react supportively to these behaviours, further pushing students away from seeking any kind of help. The findings from this qualitative study highlight the ways in which school experiences can be positive and negative for students at-risk for developing a behaviour or emotional disorder. Most 38 prominently, supportive relationships with peers, teachers, and caregivers can significantly and positively impact a students’ school experience. While youth perspectives concerning mental health (Askell-Williams & Lawson, 2015; Buchholz et al., 2015; Moses, 2010; Rickwood et al., 2007) and more specifically, school-based mental health (DeFosset et al., 2017; Huggins et al., 2016) have been highlighted in the current literature, there are few Canadian studies that have examined how secondary schools support the mental health needs of their students, particularly students struggling with their mental health. While limited, the existing literature provides some insight into student perceptions of school-based support for students with significant mental health needs. A qualitative thesis study by Semchuk (2016) explored the experiences of four secondary school students in the Lower Mainland of BC who sought and received school-based mental health support. The study identified three broad themes that shaped the students’ experiences of support at school: supportive relationships, a flexible learning environment, and the school’s potential role as a support system. In another Canadian study, Pereira and Lavoie (2016) interviewed six Grade 8 students about their perceptions of being placed in an alternate program for students with EBDs. Students who participated discussed their “tumultuous” (p. 381) pathways through school that ultimately led to being placed in an alternate program. They perceived that their chaotic schooling experiences contributed to their emotional, behavioural, and academic challenges. They described experiences of disrupted school services, lack of supports, a negative school climate, and disengaging instructional strategies as further contributing to their struggles. Participants also discussed how the physical environment of the school, the instruction and pace of their classes, and a school climate of competition contributed to their lack of school success. The 39 results of this study highlight some of the major challenges at school faced by students who experience mental health difficulties, as well as specific areas within the school, including the overall school climate and practices (e.g., disciplinary, teaching), that could be improved to better support these students. It is possible to ameliorate the school experiences of students with emotional and behavioural disorders in typical mainstream education programs; however, it is important to first learn about students’ subjective experiences at school in order to inform practices and policies (Pereira & Lavoie, 2016). Parent Involvement in Their Child’s Mental Health Support In addition to student voices, parent perspectives of their child’s school-based mental health support are extremely valuable. Despite the important role parents play in their child’s educational planning and support, there are few Canadian studies examining their perspectives regarding the school-based support their child with mental health challenges receives, as well as their involvement and participation with that support. However, given the critical role that parents can have in the success of their child’s development, including academic and health outcomes (Wang & Sheikh-Khalil, 2014), their perspectives should be considered central in the evaluation of school-based supports provided to students with serious mental health conditions. Within the existing literature, parents of children with mental health needs have reported challenges when trying to be involved in their child’s school-based support, such as feeling stigmatized and blamed for their child’s challenges by school personnel, limited communication with school staff, and insufficient individualized support (Buchanan & Clark, 2017; Carter, 2014; Lake & Billingsley, 2000; Shucksmith et al., 2011). Parents especially play a significant role when it comes to the development of their child’s IEP. In BC, parents are invited and encouraged to attend meetings regarding their child’s 40 IEP. Similar to their experiences related to school-based mental health support, parents have reported an overwhelming number of challenges related to participating in IEP meetings. These challenges include a lack of opportunity to provide input, limited participation and understanding, communication challenges, and feelings of alienation (Flanagan, 2001; Tucker & Schwartz, 2013; Zeitlin & Curcic, 2014). Zeitlin and Curcic (2014) interviewed 20 American parents about their experiences surrounding the process of their child’s IEP, as well as the document itself. Parents perceived the process as a highly emotional event. For example, they reported an imbalance of knowledge, power, and authority between themselves and school personnel. Furthermore, they did not perceive the IEP process as collaborative. Parents also shared that the IEP document labeled their child and focused more on their child’s deficits than strengths. The document was also difficult for parents to understand. To improve the IEP process, parents recommended better communication and more collaboration. They expressed a desire to play a more active role in the process and for their input to be valued more. With regards to the IEP document, parents wanted a more meaningful and simplified document that was parent-friendly and easier to read and understand. Given the importance of family-school relationships for adolescents’ academic, social, emotional, and behavioural functioning and development, it is critical to also explore parent perceptions of the support provided by their child’s school to support their child’s mental health and well-being. Teachers’ Role and Perceptions of Mental Health Support for Students Teachers are in a unique position when it comes to supporting student mental health. While they have specific responsibilities dictated by the BC Special Education manual (2016), their teaching practices, as well as the general attitudes and behaviours they hold towards mental health are critical, as secondary school students have reported teachers as being someone to talk 41 to about mental health concerns within the school environment (Ruddy, 2019). According to the BC Ministry of Education Special Education Services Manual (2016), in collaboration with other school personnel, the student, and their parents, teachers are responsible for all aspects of a student’s educational program including its design and implementation, as well as how it is monitored and assessed. Classroom teachers are also responsible for providing the adaptations, accommodations and modifications that have been set out in a student’s IEP, which may require particular adjustments to teachers’ typical teaching practices. Despite their significant role in providing support to students at school, teachers have varying views regarding what their role involves when it comes to supporting student mental health (Beames, 2020; Phillippo & Kelly, 2014). Teachers have been found to not perceive they are well equipped to deal with student mental health concerns and believe they lack the necessary training, experience, and confidence to support students experiencing mental health challenges (Graham et al., 2011; Phillippo & Kelly, 2014; Reinke et al., 2011). As more and more adolescents are experiencing serious mental health concerns, which can have a significant impact on students’ functioning at school, identifying, addressing, and accommodating these concerns have become increasingly integral to the teacher’s role at school. In an American survey-based study of educators’ perspectives of youth mental health needs in schools and their own needs for mental health training, the majority of educators surveyed, within a total sample of 206 general and special education teachers, identified the need for more resources and training opportunities about mental health disorders, behavioural management techniques, specialized skills training (e.g., social skills, anger management skills), positive behavioural supports training, and understanding trauma (Moon et al., 2017). Given the shift in their role and responsibilities, it is essential to develop a better understanding of how teachers not only 42 perceive their current role and responsibilities towards supporting students with identified mental health needs, but also the specific supports they are providing to students. Given the increase in the number of students identified as needing some level of support due to behavioural or mental health concerns, it is important to consider how these changes are affecting classrooms. Teacher perceptions and experiences can provide valuable contextual information for developing a more complete understanding of the mental health support services a secondary school provides its students. School Mental Health Professionals’ Role and Perceptions of Mental Health Support Given their specialized training and skillset, school mental health professionals such as school counsellors and school psychologists are primarily responsible for directly supporting students with mental health difficulties. A major component of a school mental health professional’s role involves collaborating with parents to support students’ well-being and learning outcomes (Christensen, 2004). While previous literature has documented that parents perceive school counsellors as effective and beneficial for students’ well-being (Copeland et al., 2024; Harrison et al., 2023), other studies have reported challenges within this home-school relationship (Bignold & Anderson, 2023; Copeland et al., 2024; Vaishnavi & Kumar, 2018). For example, in Collins and colleagues’ (2024) qualitative study involving interviews with 10 parents that explored their perceptions and expectations of school counsellors, the authors found that parents perceived school counsellors’ primary responsibility as creating a safe and accessible environment for students. They also viewed a counsellor’s role as being first responders to students experiencing mental health difficulties. In addition, school counsellors were perceived as providing proactive individual and group or classroom mental health and career support through consultation with school staff, providing psychoeducation and coping strategies to 43 students regarding mental health resilience, and supporting students with career goals. Participants also perceived consultation and collaboration with parents and outside agencies to be part of school counsellors’ role. Lastly, parents in this study identified counsellors’ lack of visibility and accessibility within the school, and lack of transparency about their role as barriers to working with them. These findings are generally consistent with many of the responsibilities of school counsellors outlined by the Ministry of Education (2016). Findings from Collins and colleagues’ study alongside the responsibilities outlined in the provincial government’s manual demonstrate the multitude of varied responsibilities school mental health professionals are expected to manage every day. Although a portion of their time is allocated to directly supporting students, families, and school personnel through counselling, consulting, and collaboration, school mental health professionals often spend a significant amount of their limited time fulfilling other responsibilities within the school that are not necessarily directly related to supporting student mental health (Albritton et al., 2019; Bahr et al., 2017; Fabek et al., 2023; Mau et al., 2016). In a systemic review examining time allocation of school mental health professionals (Fabek et al., 2023), the authors found that all school mental health professionals spend between 22-41% of their time completing documentation and paperwork, as well as activities that were unrelated to their field. As a result, and consistent with the CPA position paper highlighting the underutilization of school psychologists across Canada (2022), the researchers concluded that mental health professionals working in schools underutilized their specialized skillset and suggested that school administrators find ways to maximize their expertise. Expectations of the school to address and support student mental health are heightening given the increase in student mental health difficulties. As a result, in order for a school to 44 provide appropriate mental health services, it is essential that school personnel have a shared understanding of what is expected when it comes to supporting student mental health in this setting (Beames et al., 2022). To explore this shared understanding, Beames and colleagues (2022) conducted a qualitative study that examined the perceptions of 91 secondary school teachers and 83 counsellors/psychologists regarding the school’s role in student mental health. Using thematic analysis, the authors discovered four themes regarding how teachers and counsellors perceive the school’s role regarding student mental health. The first theme, Support, outlined the different ways that participants perceived schools to support student mental health, including the provision of a holistic model of care, safety and protection, and advocating for students. The second theme, Being on the Frontline, referred to participants’ shared perception of being the primary access point for mental health services and described the ways in which teachers and counsellors provided mental health support to students including identification and assessment of mental health problems, prevention of mental health problems, delivery of interventions, and referrals to more appropriate services or programs. The third theme, Collaboration, referred to participants’ perception that the school played a major role in collaborating with others, including parents and other support services, to support student mental health. Finally, the fourth theme, Education, described the school’s role in providing mental health-related education to students, specifically mental health literacy and help-seeking. In BC, the Ministry of Education and Child Care essentially defines the school’s role in supporting student mental health; however, how this looks practically for those working within the school building has not yet been explored within a secondary school in BC. While the aforementioned studies shed light on school mental health professionals’ roles and responsibilities and their perspectives on the school’s role in providing mental health support services to students, these 45 research studies lack the Canadian school context that is essential for understanding the roles of school counsellors and school psychologists in this country. Perceptions of School Administrators of Mental Health Support for Students School administrators play a significant role within the school through their influence on the systemic and structural factors that affect the school’s functioning on a daily basis (Moon et al., 2017). School administrators make important decisions about the provision of services and supports, as well as the allocation of resources, including those most important to students with disabilities and diverse abilities (Barrett et al., 2013). They are also responsible for developing the school’s infrastructure and for acquiring the ongoing funding in order for support services and professionals to be made available for and accessible to students and families. Needless to say, administrators are central to their school’s operations and to the support the school is able to provide to students with significant mental health difficulties, despite not always being directly involved in each student’s case. Although they hold such positions of power within their schools, their perceptions are largely missing from the existing school-based mental health literature. In Moon and colleagues’ study (2017) examining educators’ perspectives of the mental health needs of youth in schools and their own needs for mental health training, 127 administrators also participated. One of the research questions specifically explored the differences in the perceptions of students’ mental health issues and mental health promotion based on participants’ roles (i.e., administrator, mental health professional, teacher). Compared to teachers, mental health professionals and administrators were significantly more concerned about students’ mental health challenges and were significantly more likely to believe that students and families needed greater access to community-based mental health services compared to teachers. Furthermore, school administrators were significantly more likely to 46 believe that addressing students’ mental health challenges was a part of their role, as compared to teachers. The findings from this study are significant, as they suggest that although school administrators are not as involved as teachers in direct day-to-day interactions with students, administrators perceive students’ mental health difficulties, and the accessibility of supports to be a major concern within the school. If this is the case, given their position and their responsibilities, school administrators not only have the power to make student mental health a priority within their own school, but bring it to attention at the district level, and to work toward allocating the appropriate funding and resources to mental health support. School administrators were also involved in Huggins and colleagues’ (2016) qualitative study regarding the stigma surrounding the use of school mental health services. Semi-structured interviews were conducted with five key informants from three different high schools, including the principal. Principals in this study reported that their school-based mental health services could be better utilized by students and relayed concern for the effectiveness of their mental health services. To improve services, they suggested that teachers should be better educated about identifying and recognizing signs of students’ mental health difficulties and that having more school psychologists or more time with their school psychologist would be beneficial. Previous findings, although limited, suggest that administrators perceive student mental health challenges to be a concern (Moon et al., 2017), but that school-based mental health services could be more effective and be better utilized (Huggins et al., 2016). Research questions posed to school administrators in these previous studies do not go into detail about the nature and effectiveness of these mental health services, nor do they inquire about less formalized and concrete supports within the school, such as the school’s climate, including students’ feelings of connectedness. Furthermore, previous literature that involves the perspectives of administrators 47 do not specifically address the needs of students identified as having significant mental health difficulties. The current study aims to fill this gap within the literature by involving school administrators. Their voices may provide valuable insights regarding systems-level challenges and changes that other stakeholders within the study may not capture. Chapter Summary In this chapter a review of the existing literature related to adolescent mental health in BC and Canada and its impact on school functioning is provided. The important role of schools in supporting adolescent mental health is also highlighted in addition to supports that are required as outlined by the Ministry of Education (2016). Provincial strategies and initiatives directed toward supporting student mental health are also outlined. Finally, existing research exploring the roles, as well as the perceptions and experiences of stakeholders within the school community regarding school-based mental health, was provided. A review of the current literature emphasizes the absence of qualitative research focusing on school-based mental health support within Canada that involves multiple stakeholders within the school community. The current study aims to fill that gap by investigating how key stakeholders within a secondary school in BC support students experiencing mental health difficulties. Identifying the school’s areas of success and improvement, from multiple sources within the school, can provide the school with valuable knowledge on how to better support its students. 48 Chapter 3: Methodology Overview In this chapter, the methodological framework of the current study, a case study, and its epistemological and theoretical underpinnings are discussed. Participants, including how they were recruited, as well as data collection procedures, are also discussed. Finally, in this chapter the ethical considerations, data analysis procedures, and how research quality was maintained throughout the study are described. Purpose and Research Question The purpose of the present study was to explore and understand the ways in which a secondary school in the Lower Mainland of BC provides support, through its practices and overall climate, for student mental health. For the purpose of this study, practices refer to the behaviours and attitudes of those attending and working at the school, as well as the processes in place to support student mental health. The research question for the study was: How do key stakeholders within a secondary school support the needs of students experiencing mental health challenges? Epistemological and Methodological Framework Method, methodology, and epistemology are interrelated and fundamental components that provide a foundational framework for qualitative research (Carter & Little, 2007). The ontological and epistemological assumptions of the social constructionist perspective guided the present study. Within social constructionism, our understanding and perception of the world, or what we know to be “true,” are constructed by our social relationships, as well as shaped by the culture and time in which we live (Burr & Dick, 2015; Gergen, 2015; McNamee, 2012; Schwandt, 49 2003). Furthermore, language is fundamental to social constructionism as it produces our realities, including how we give meaning to and interpret the world (Braun & Clarke, 2022; Gergen, 2015). As a result, and contrary to the post-positivist approach, research guided by social constructionist assumptions does not seek to discover a single conclusion that is verifiable and considered fact but instead focuses on the subjective interpretations of reality that are created through participants’ experiences and perceptions, and the meaning they make of those (Braun & Clarke, 2022; Burr & Dick, 2015). According to Braun and Clarke (2022), social constructionism in the context of thematic analysis “is concerned with exploring what or how reality has been ‘made’ (constructed), and usually what the implications of this are” (p. 183). Informed by the principles of social constructionism, I sought to describe, understand, and interpret how a secondary school supports students’ mental health from the participants’ perspectives and the meaning they have constructed from their experiences and perceptions (Yazan, 2015). Through the application of a social constructionist approach to the present study, participants’ perceptions and experiences regarding the school’s climate and practices around mental health support were recognized as representing multiple versions of their own socially constructed reality. Diverging from the post-positivist approach, the social constructionist approach positions the researcher as being actively involved in the data analysis stage of the research process. Social constructionism acknowledges my unique positionality as the researcher and embraces rather than tries to eliminate the preconceptions, beliefs, biases, perceptions, and experiences that inevitably influence my approach to the research, including the stages that precede data collection; my interactions with participants, including conversations elicited through semi-structured interviews; as well as my interpretation and understanding of the collected data. This 50 implicit collaboration between myself and the participants produced multiple layers of interpretation that ultimately resulted in a comprehensive understanding and storytelling of how the school supported student mental health (Merriam, 1998). Goal and Purpose of Case Study Methodology A case study was selected as the methodology for this study as it is methodologically cohesive with the social constructionist approach that oriented the current study. While definitions of a case study vary amongst key researchers and methodologists, a case study, as applied to the current research, involves a comprehensive exploration of a social entity while taking into consideration the context surrounding the case (Yazan, 2015; Yin, 2018). A qualitative case study involves a comprehensive description, analysis, and understanding of a single thing in its natural context, which can include a program, institution, a person, or a process (Creswell, 2013; Merriam, 1998). Most importantly, the boundaries of the phenomenon being studied need to be clearly identified and described in order to define a case. For the present study, a secondary school in the Lower Mainland of BC was the case. Case Study Design Overview A single case was selected for this case study as a single school rather than multiple schools was more manageable and feasible for an unfunded dissertation project. Focusing on a single school allowed for more time and focused dedication to collect more in-depth data in order to develop a well-informed and rich understanding of the case. An embedded single-case study design was selected (Yin, 2018) as there were many stakeholders within the school community involved in providing and receiving support for students with mental health needs and creating a safe and supportive environment, as well as individuals affected by this support. 51 Within the embedded single-case study design, the school was the case, and ultimately the focus of the case study. The embedded subunits included general and special education students; parents of general and special education students; general and special education teachers and educational assistants (EAs); mental health professionals including school counsellors, the school psychologist, and the youth engagement worker; and administrators including the vice-principal and principal. Both the case and the subunits are situated within a context (Yin, 2018). Furthermore, the embedded units enhanced the case by providing additional context (Maurya, 2024). Additionally, this case study design strengthened the case as I was able to examine how each subunit related to and influenced one another, which allowed for a more enriching, comprehensive, and holistic understanding of the case and phenomenon being studied (Baxter & Jack, 2010; Maurya, 2024). Figure 1 Embedded Single Case Study Design 52 The Case and Its Boundaries Within a case study, it is important to both define and bound the case (Merriam, 1998; Yin, 2018). Bounding the case is essential as it has significant implications throughout the research process including data collection and analysis. This secondary school was selected based on convenience as the administrator elected to participate after receiving information about the purpose of the study and what was involved on the school’s part to take part as the case of the study. The boundaries of the case involved what occurred within the physical building of the secondary school and involved those who attended, worked at, and who were ultimately a part of the school’s community. The embedded subunits were the groups of participants involved in data collection. The real-world context in which the case is situated provides a holistic understanding of the case (Harrison et al., 2017; see Chapter 4 for a comprehensive description of the context of the case). To gather contextual information related to the school, I recorded observations of the school’s physical environment, as well as during school-based team meetings. For additional context, I reviewed the school district-wide resources and programs that were available to students and that impacted the individual school’s provision of supports. Additionally, provincial policies and strategies related to adolescent and school-based mental health, as well as the school curriculum developed at the provincial level, offered important contextual information to explore the phenomenon of the present study. The time frame of the case, data collection, and the general investigation spanned half of a school year (December 2022 to May 2023). Merriam’s (1998) three distinctive attributes: particularistic, descriptive, and heuristic, were applied in the case in this study. The case was particularistic as it focused on a specific phenomenon, a secondary school’s practices and climate towards supporting students’ mental 53 health and academic needs. Drawing from multiple sources of data, the findings of the case study involved a detailed description and analysis of the school’s mental health support practices and climate, including the complex system by which the school is bounded. Lastly, the case provided a clearer picture and deeper understanding of the various ways the school supported students who were struggling with their mental health by elucidating the strengths of the current provision of supports as well as the challenges and barriers that the school faced in its effort to support students. In addition, the researcher went beyond description, given the role of interpretation within social constructionism and reflexive thematic analysis. Additionally, a vital component of this case study was to inform and provide insights regarding future research on the topic of school-based mental health, as well as case study research. Data Collection Procedures Participant Recruitment The Secondary School. To recruit the secondary school, I received assistance from the former principal of the school district’s alternate education secondary school where I was completing a practicum placement. He distributed information about my study to the administrators of all the secondary schools within the school district. Once one of the administrators of the secondary school who participated expressed interest, I was connected via email with the vice-principal and had a meeting to discuss the study. This meeting occurred at the end of the school year (June 2022) prior to data collection. The vice-principal gave me a tour of the school and introduced me to several teachers and the counsellors. Ongoing recruitment and data collection took place during the 2022-2023 academic year. Before individual participants could be recruited, I obtained ethics approval from the school district and the Research Ethics Board at the University of British Columbia (UBC). 54 School Personnel. I worked with the vice-principal to recruit individual participants within the school community. I did a presentation with information about the study at a staff meeting at the beginning of the school year as an initial way to recruit teachers and school counsellors. Following the presentation, I distributed paper letters with information outlining the study that was included in the presentation. This letter of information included my contact information, if they were interested in participating. I also emailed each school staff member individually with details about the study to seek their participation. In addition, I recruited school personnel by attending School-Based Resource Team (SBRT) meetings. Those interested in participating returned my email and I then scheduled a phone call or Zoom meeting with the individual to review the consent form. After receiving verbal consent, I sent the staff member the consent form via email for them to sign, as well as a background questionnaire. Once the participant returned the signed consent form, we scheduled a time to complete the semi-structured interview either in-person or over Zoom. Although participants were asked to return the background questionnaire prior to the interview, some participants returned it following the interview. Students. Initially, my goal was to recruit special education students with R designations (Students Requiring Moderate Behaviour Support or Students with Mental Illness) or H designations (Illness Students Requiring Intensive Behaviour Intervention or Students with Serious Mental Illness) as I perceived them to be the ones in the best position to discuss their perceptions and experiences of receiving support related to their mental health difficulties. However, I learned that students receive mental health support regardless of whether they have a designation, and in fact, most students do not necessarily have a designation that specifically addresses their mental health. There are many students who either do not have a designation or 55 have designations in other categories who also or indirectly receive support related to their mental health. Therefore, although I was still looking to recruit students with an R or H designation, after consultation with my supervisory committee, I expanded my recruitment to students with and without a designation or diagnosis but who still had experience receiving support for their mental health at school. Regardless of a designation, I categorized these students as special education students for the purpose of this study. In addition to capturing the perspectives of students who receive formal or informal support at school for their mental health, I also recruited students who did not receive ongoing support at school specifically as a result of their mental health. I categorized these students as general education students. Special education students, particularly those with a designation, were recruited through the support of the vice-principal, counsellors who are case managers for students with R and H designations, and the teacher of the Pathways1 program, a program within the school that supports students struggling with social, emotional, and/or behavioural challenges that are impacting their learning. All were sent paper and electronic copies of letters with information about the study to share with students. I also attended several classes across the grades and presented information about the study and what participation involved. I distributed letters of information to students in these classes. Those who were interested in participating in the study gave me their contact information at the time or were asked to directly contact me later to obtain further details about how to take part. Parents. Parents, particularly those of students with a designation, were again recruited with the support of the vice-principal, school counsellor, and Pathways teacher. Information 1 Pathways is a pseudonym for this school district program. 56 about the study, including my contact information for those interested in participating was also put in the Parent Advisory Council (PAC) newsletter. In addition, I contacted the chair of the PAC to attend a PAC meeting to present information about the study. However, I was informed that due to low attendance, it was deemed unnecessary for me to attend in person but that they would continue to publish information in the PAC newsletter. Parents were also recruited through their child’s interest in participating in the study. Those who were interested in participating in the study directly contacted the researcher to obtain further details about how to take part. Participants Overview. Twenty-two individuals participated in the present case study. In addition, the secondary school that was the focus of the case study was considered a participant. Participants included students, parents, teachers, EAs, mental health professionals2 (i.e., school counsellors, the school psychologist, and a youth engagement worker) and administrators. As each case study has its own unique boundaries, there is no predetermined or suggested number of participants that is needed within a case study. It was important to involve stakeholders who held different positions within the school community in order to gather a holistic view of the school and how it supported the mental health of students, particularly those who had been identified as needing it most. Each of these positions was essential to include in the case study, as they were each an important stakeholder affected by, concerned with, or responsible for the support provided to students for their mental health, including the overall climate of the school towards student 2 “Mental health professional” was used by the researcher as a term to categorize the school counsellors, school psychologist, and the youth engagement worker who participated. These participants did not explicitly self-identify as mental health professionals. In addition, although the youth engagement worker was not formally trained in the provision of mental health intervention, she was categorized in this group given that her duties often involved informal mental health support, particularly within the Pathways program. 57 mental health. Each participant provided a unique voice and perspective that contributed to a better understanding of the ways in which students’ mental health and well-being were being supported. Secondary School. The secondary school that participated in this case study was located in the Lower Mainland of BC. It was not an alternate education secondary school. Consistent with the initial goal of this case study, the school, a public school, included students from Grades 8 to 12. During the 2022/2023 school year, 598 students were enrolled at the school. At the time of data collection, there were three students assigned an H designation and 14 students assigned an R designation. This school had two administrators, one principal and one vice principal; two full-time school counsellors; and one school psychologist who worked at the school one day every two weeks. During the academic year of data collection, one of the school counsellors was on leave; however, a retired school counsellor who had years of experience working in the district replaced that school counsellor during the time of the study. There were three special education teachers, which included the teacher of the Pathways program. In addition, there were 29 general education teachers and 10 EAs. The school also had a youth engagement worker who primarily worked within the Pathways program. In addition to the Pathways program, the school offered counselling and school psychology services (see details about the Pathways program and these services in Chapter 4). Students and Parents. Five secondary school students participated in the current study. Although each of these students identified as either having a diagnosed mental health condition or having had ongoing or previous mental health challenges, two of these students were 58 receiving support at school for their mental health difficulties. One of these students, Lucy3 had a designation (Category R) that was specifically related to their mental health condition. The other student, Kyle, had a designation related to his learning needs, but due to the impact of his mental health challenges on his school attendance and academic performance, had recently started receiving mental health-related support at school. The other three students were considered general education students as they either did not have a special education designation, or they had a designation that was unrelated to their mental health. For example, Chloe’s designation pertained to her learning needs, and although Anna had recently received diagnoses of depression, generalized and social anxiety, she was undecided about whether she would seek a designation within the school system. Six parents participated in the study, two of whom were a couple and completed their interview together. Five of these parents were parents of the student participants described above. Only one parent, Christina, did not have an adolescent who also participated in the study. Although Christina’s adolescent’s designation at school did not address her mental health difficulties; she nevertheless received mental health-related support. Four of the parents who participated, Karla, James, Diane, and Christina, were parents of students who received support that specifically addressed their mental health difficulties. The other two parents, Jessica and Vanessa, were parents of the students, Chloe and Anna, respectively, who were not receiving mental health-related support at school (see Table 1 for student and parent participant characteristics). 3 All participant names are pseudonyms to protect participant confidentiality. 59 Table 1 Student & Parent Participant Characteristics Student Name (Gender)1 Parent Name (Gender) Student Age Student Grade Ministry of Education Designation3/Self-Reported Diagnosis or Mental Health Condition Lucy (Female) Karla & James (Female & Male) 17 12 R Designation/ADHD, Social Anxiety Kyle (Male) Diane (Female) 16 10 Q Designation/ADHD, Depression, Anxiety, Specific Learning Disorder with Impairment in Written Expression Chloe (Female) Jessica (Female) 15 10 Q Designation/ Specific Learning Disorder with impairment in reading, Anxiety, ADHD Anna (Female) Vanessa (Female) 15 9 None/Depression, generalized and social anxiety Natalie2 -- -- 12 None/Anxiety, Depression -- Christina (Female) 17 12 P Designation/Anxiety, ADHD, OCD, Depression 1Pseudonyms were used to protect participant confidentiality. 2As Natalie did not return her background questionnaire, her age is unknown and additional information was gathered from the interview. 3R designation = Moderate Behaviour Support or Mental Illness; Q designation = Learning Disability; P - Gifted Lucy and her parents, Karla and James, participated in the study. Lucy was a 17-year-old student in Grade 12 who identified as female. She had attended the school since Grade 8. Lucy had been given an R designation about a year ago as a result of her challenges associated with Attention-Deficit/Hyperactivity Disorder (ADHD) and social anxiety. Her parents reported frustrations regarding the lack of support she was initially receiving; however, once Lucy became part of the Pathways program, the support she was receiving was perceived to better 60 meet her needs. Lucy reported enjoying school and described the school as “a very good community.” According to her parents, Lucy is funny, kind, and “quite the empath.” Kyle, a 16-year-old Grade 10 student who identified as male participated in the study as did his mother Diane. Having attended the school since Grade 8, Kyle had had a designation as a student with a learning disability for six years. He also had diagnoses of ADHD, depression, and anxiety, the combination of which had significantly impacted his school attendance and performance. Described by his mother as creative and “super musical,” Kyle also loved music. Kyle was part of the Pathways program. Chloe, a 15-year-old student in Grade 10, and her mother, Jessica, participated in the study. They both identified as female. Chloe had attended the school since Grade 8 and had had a designation as a student with a learning disability since Grade 2. She also disclosed diagnoses of anxiety and ADHD. Chloe reported really liking her school in part because the school “supports people with different difficulties.” Although Chloe predominantly received learning support, her parent, Jessica, described frequently working with the student’s school counsellor and special education teacher to fully support Chloe. Anna was a 15-year-old student who was in Grade 9 and who identified as female. Her mother, Vanessa, also participated in the study. She had attended the school since Grade 8. Anna did not have a designation; however, she had disclosed having been diagnosed with depression, as well as generalized and social anxiety, shortly before the study interview. Although Anna reported that she did not particularly enjoy attending school, she described being part of the school community through her involvement in sports and the band. Anna’s mother, who described her as high achieving and emphasized the importance and value of her privacy in the context of mental health. 61 Natalie was a Grade 12 student, was in the Performance Learning Program, which she described as being “built off of the pillars of project-based learning and outside of the classroom learning.” The Performance Learning Program is a rigorous mainstream program that involves project-based learning, use of technology, and emphasizes learning beyond the classroom. She had attended the school for Grades 8 and 9 before transferring to another school for Grade 10. Natalie returned to the school for Grades 11 and 12. She also disclosed having previously missed a significant amount of school in previous years as a result of her mental health challenges, including anxiety and depression. She did not have a designation or IEP but noted that her teachers were aware of her mental health difficulties. Christina was the mother of a student who was 17 years old and in Grade 12. Christina identified as female. Her child had attended the school in Grade 8 but then moved for a year before returning to the school for Grades 10 to 12. Since 2016, Christina’s child had had a designation as a gifted student (P Category). She also struggled with mental health difficulties including depression, and had diagnoses of Obsessive-Compulsive Disorder, ADHD, and anxiety. School Personnel. In total, 12 staff members participated in the study, including three general education teachers, one special education teacher, two EAs, two school counsellors, a school psychologist, a youth engagement worker, the vice-principal, and the principal (see Table 2). While the teacher of the Pathways program initially agreed to participate, she ultimately declined. However, she consented to having a conversation about the program informally with me. 62 Table 2 School Personnel Participant Characteristics Name1 Identified Gender Years at School Years of Experience in Role Position Hannah2 -- -- -- Special Education Teacher Dan Male 18 18 General Education Teacher Olivia Female 8 8 General Education Teacher Eva Female Almost 1 7-9 General Education Teacher Victoria Female Almost 1 3.5 Educational Assistant Amanda Female 5 5 Educational Assistant Evelyn Female 13 23 School Counsellor Thomas Male 4 months 33 School Counsellor Nicole Female 3.5 15 School Psychologist Maria2 -- -- 10 Youth Engagement Worker Lisa Female 2 9 Vice-Principal Julia Female 2.5 8 Principal 1Pseudonyms used to protect participant confidentiality. 2Participants did not return background questionnaire. Special Education Teacher. Hannah was one of the special education teachers at the school. She taught students in Grades 8 through 12. As a special education teacher, she was a case manager for students with identified learning needs, as well as for students with chronic health conditions, hearing impairment, and students with Autism Spectrum Disorder. As part of this role, she co-created students’ IEPs. In addition, as part of her role, she advocated on students’ behalf in part by assisting classroom teachers with implementing adaptations for the students. She also attended weekly SBRT meetings. Within the learning support classroom 63 setting, she typically supported students academically. In addition to her experience and credentials as a special education teacher, Hannah also had a background in counselling.. General Education Teachers. Dan, a male-identifying general education teacher who had 18 years of teaching experience. Olivia, who identified as female, had taught at the school since 2017. She taught several Grade 8 to 12 courses, including Humanities and English. At the time of the interview, she had eight years of teaching experience, all of which had been spent at the school. Eva was the third general education teacher who participated. She identified as female. She had seven to nine years of teaching experience and almost one year of teaching at the school. She taught several courses from Grades 8 to 12, including Social Sciences and English. While the other two general education teachers’ interviews took place over Zoom, Eva’s interview took place in-person in her classroom, which allowed me to observe some of the ways in which she implemented mental health-related strategies. For example, on the board she had written about different types of rest and had a gratitude prompt. In addition, she had another activity on the board that was intended for students to “unplug.” Educational Assistants. Victoria was one of two EAs who participated in the study. She worked with “a huge variety of students with different complex needs” in Grades 8 and 9. She had 3.5 years of experience working as an educational assistant and almost one full year working at this school. In her role, she reported supporting students’ academic, personal, and social well-being. Amanda was the second EA who had five years of experience working as an educational assistant, all of which had taken place at this school. She worked with students in Grades 8 to 12. Amanda reported that she had previously typically worked with low incidence students who followed a modified education program. During the academic year this interview took place, however, she was providing more academic and behavioural support to students identified as 64 having behavioural difficulties. Mental Health Professionals. Both school counsellors participated in the study. Each counsellor was assigned alternate grades and had a caseload of about 250 students each. Counsellors were also the case managers for students identified as having behavioural and/or mental health needs (R and H designations). In addition to supporting students’ mental health through the provision of counselling services, the counsellors were also responsible for course programming. In addition, they helped students transitioning from middle school to Grade 8, attended and/or chaired SBRT meetings, and were involved in the Pathways program. They also supported teachers with classroom management. Evelyn had been working as a school counsellor since 2010, the same year she started working at this school. She had a Master’s in Counselling Psychology. Thomas was the other counsellor who had been working at the school for only four months, as he was covering the position while the permanent school counsellor was on leave. He had 33 years of experience working as a school counsellor, including having many years of experience working at other secondary schools within the district. The school psychologist, Nicole, had been in this position at this school for 3.5 years and she had 15 years of experience as a school psychologist. She spent a full day at the school once every two weeks and attended Extended School Based Resource Team (ESBRT) meetings where she was involved in making decisions around more specialized supports for students. A significant part of her role was completing psychoeducational assessments with students. In addition to a school psychology background, Nicole had many years of counselling experience. Youth Engagement Worker. The youth engagement worker, Maria, was primarily part of the Pathways team; however, she supported all students within the school. She described her role as consisting of three parts: outreach worker (e.g., taking students to appointments, going to the 65 hospital, driving students to school, going on a hike, etc.), academic support, and mental health support (e.g., supporting a student who is in crisis, connecting with students who may be struggling, connecting students with the counsellor, etc.). Maria had been in this role for 10 years and described herself as “a bridge builder” as she connected students to professionals in the school building, as well as to the alternate education school in the district or other community agencies. Administrators. Lisa was the vice-principal at this school for the past 2.5 years. She had nine years of experience as an administrator and 22 years of experience as an educator, which included years of experience working at a former alternate education school in the district. She also worked within the Pathways program at other secondary schools within the district. Julia, the principal, had eight years of experience as an administrator and 2.5 years of experience as the principal of this secondary school. In addition to her education background, she had been a high school counsellor for eight years. Sources of Data Overview Multiple sources of evidence are commonly used within a case study methodology as data collection through multiple sources enhances the holistic understanding of the phenomenon. As a result, data collection in the current case study involved multiple sources of data including a background questionnaire, semi-structured interviews, observations, and document review. Background Questionnaire Prior to conducting the interview, each participant was asked to complete a short background questionnaire. Although background questionnaires were administered to participants prior to the interview taking place, they were collected either before or after the 66 interview. Three participants did not return their background questionnaires. The questionnaires consisted of four to seven questions and varied depending on the participant’s position (i.e., student, parent, teacher/EA, mental health professional, administrator). The questionnaires included questions about age, gender, grade, number of years the student attended the school, number of years of experience, whether students had a designation, etc. (see Appendix F). Individual Semi-structured Interviews Data was primarily gathered through semi-structured interviews with each individual who participated. There was a total of 22 interviews conducted. Although focus groups were also initially proposed as a data collection method with certain groups of participants, early concerns about confidentiality and being able to speak open and honestly in a group interview, particularly amongst other teachers, were raised. After considering these concerns and establishing early on in the participant recruitment phase that school personnel, as well as other groups of stakeholders, would be more likely to participate in individual interviews rather than in focus groups, these concerns were brought to the attention of the research committee. It was decided that data collection could move forward with individual interviews instead of focus groups. Semi-structured interviews are commonly used when collecting data within a case study. In the present study, interviews documented the participant’s perspective regarding how student mental health was being supported at the school and allowed participants to provide a rich and detailed account of their experiences, as well as their perceptions (Braun & Clarke, 2013; Smith & Osborn, 2008). Interviews also allowed the participant and me to engage with, learn about, and think critically about the support that was provided to students and the ways in which it did or did not meet students’ needs. Interview schedules that consisted of several open-ended questions that varied based on the participant group guided the interviews (see Appendix G). I 67 used the interview schedules flexibly and modified them with additional questions and probes, when necessary, based on participants’ responses and/or when relevant topics of interest were raised (Braun & Clarke, 2013). After an initial meeting to review consent and once written consent form was obtained, I then scheduled a time to meet with the participant to complete their interview. For three of the students who participated, their interview was scheduled via email communication with their parents. Participants had the choice of completing their interview in-person or virtually over Zoom. Six interviews took place in person and 16 took place over Zoom. Interviews that took place in person were conducted either in the participant’s office or classroom, or in a private room in the counselling wing or office area of the school. For interviews that took place over Zoom, participants were asked to find a private location with minimal noise and interruptions to ensure confidentiality. Interviews that took place in-person were audio recorded while interviews that took place over Zoom were video recorded. Participants who chose to complete their interview over Zoom did not have to be on camera if they did not feel comfortable being video recorded. Interviews ranged in length from 30 to 75 minutes. Interview audio/video recordings were later transcribed. I transcribed half of the transcripts and the other half were transcribed by three Master’s-level research assistants. Observations Overview. In a case study, observation, both formal and informal, occurs throughout the entire process (Simons, 2009). Observation can be a useful approach to data collection as it can provide important contextual information when interpreting findings from other sources (Simons, 2009). Observations of the physical environment of the school took place. In addition, I attended and observed three SBRT meetings and two ESBRT meetings (see below for more 68 details). Given the importance of context within a case study, observations made during these meetings and of the school’s physical environment in combination with semi-structured interviews contributed to the goal of providing a rich description of not only the context of the school, but the support that it provided students who experienced mental health difficulties (Simons, 2009). These observations, particularly those made during the ESBRT and SBRT meetings, served to triangulate data collected through interviews, as attending these meetings allowed me to experience first-hand some of the ways in which the school provided and approached the provision of support that had been discussed during interviews. Physical Environment. The physical environment of a school has been characterized as a component of a school’s climate (Zullig & Kooperman, 2010). Observations of the school’s physical environment were made on occasions when I was present at the school. I intentionally recorded observations of areas of the school that appeared to display materials relevant to students’ mental health. My observations targeted areas such as student services area and the front entrance near the office, that appeared to have publicly displayed materials such as posters, advertisements, and resources related to mental health and inclusivity. Relevant observations of one particular classroom were also recorded as part of an interview with a general education teacher during which the physical environment of the classroom was discussed. School Based Resource Team (SBRT) and Extended School Based Resource Team (ESBRT) Meetings. Students struggling with their mental health were supported through the SBRT and ESBRT. The role and purpose of the school’s SBRT and ESBRT were consistent with those outlined by the Ministry of Education Special Education Services: A Manual of Policies, Procedures and Guidelines (2016). According to the Ministry of Education Special Education Services Manual (2016), the purpose of the SBRT was to collaborate on: classroom strategies 69 and supports; planning and coordination of services for a student; planning school wide assessments used to determine additional supports for individuals or groups of students; access to additional school, district, community or regional services; planning and coordination of services in the school, and for transitions to other programs; and identifying a case manager. During the SBRT and ESBRT meetings, which occurred on a weekly and bi-weekly basis respectively, students identified by school personnel, along with the student and their parents, as needing additional support (e.g., learning, behavioural, social-emotional) beyond the universal school-wide supports were discussed. The school team, which included administrators, counsellors, the school psychologist, learning services teachers, the Pathways program teacher, and relevant classroom teachers, collaboratively developed and coordinated detailed support plans involving school- and/or district-based services for these students. It was intended to be a collaborative problem-solving process. My observations consisted of the types of supports that were discussed and recommended, as well as the ways in which school staff discussed, analyzed, and interpreted the student’s behaviour and challenges; the language that was used; the attitudes of school staff while discussing students, and the approaches that were taken to support students. Document Review Document review was also used as a data collection method in this case study. I reviewed various national, provincial, and school district documents pertaining to inclusive education guidelines and mental health policies that would provide further contextual information. I reviewed reports that addressed mental health and the need for supports across Canada, including Changing Directions Changing Lives: The Mental Health Strategy for Canada (Mental Health Commission of Canada, 2012), The Mental Health Strategy for Canada: A Youth Perspective (Mental Health Commission of Canada, 2015) and Evergreen: A Child and Youth Mental Health 70 Framework for Canada (Kutcher & McLuckie for the Child and Youth Advisory Committee, Mental Health Commission of Canada, 2010), At the provincial level, I reviewed the Ministry of Education’s Special Education Services: A Manual of Policies, Procedures and Guidelines (2016), MHiS Strategy and A Pathway to Hope: A roadmap for making mental health and addictions care better for people in British Columbia. In addition, I reviewed several school district handbooks that described in detail services that were offered to students and families that related to supporting students with mental health concerns. These handbooks included those outlining inclusive education learning services, the Pathways program, counselling services, and the alternate education program. Reviewing and analyzing national, provincial, and school district documents pertaining to inclusive education guidelines and mental health policies provided important contextual information about the system in which the school operated in its efforts to provide support to students with mental health concerns. In conjunction with the semi-structured interviews and observations, these documents provided additional information about the programs and services that were offered by the school district. Additionally, they provided information about the guidelines and procedures the school was required to follow in providing support to students and families. Furthermore, some of these documents shed light on some of the limitations and pressures the school operates within, and they also outlined what the province envisioned and goals they were striving for in supporting students who experienced mental health challenges. Furthermore, one student gave me consent to review her IEP. Reviewing the student’s IEP provided useful, documented information regarding how the student was being supported, including the accommodations and strategies that were being offered and implemented. The student’s IEP also complemented and corroborated data collected through interviews with other 71 participants. Although reviewing the student’s IEP was also intended to serve as a basis for interview questions with them and their parent who participated, neither the student nor their parent had been involved in creating the document. At the time of the interview, the student had only recently been given a copy, and the parents had never previously seen the student’s IEP. Reflexive Journal Throughout the research process, I used a reflexive journal to record my thoughts and reflections, emotional responses, decisions, notes, experiences, and questions that arose for me. My reflexive journal allowed me to explore how my positionality and assumptions shaped the research. As a starting point, I reflected on aspects of my identity that may have an impact on different parts of the research project, which I outlined in Chapter 1. Throughout the study I returned to my reflexive journal to critically and thoughtfully examine my biases and interpretations that stemmed from my social identities as well as experiences. For example, as I previously disclosed a belief that I did not perceive IEPs to be useful or effective for students with mental health difficulties, I used my journal to reflect on this bias and how it might influence my interview questions or my data interpretation. Through reflexivity, I tried to be more aware of how I was asking questions pertaining to IEPs during interviews and my responses to participants’ comments (i.e., try to be neutral), as well as the direction to which I was leading these discussions. Following interviews with participants, I used my reflexive journal to record reflections and emotions regarding my experience, including how I interacted with the participant, overall impressions of the interview, as well as prominent takeaways from the interview or interesting and relevant discussions that occurred. For example, following my interview with my first student participant who was not very talkative and provided brief responses to questions, I reflected in my journal not only about why this student may have 72 presented this way (e.g., anxious, shy, tired, etc.), but also how I as the researcher may have influenced their behaviour during the interview. I reflected upon my responses to this student’s responses and the changes I could make to make participants, especially students, more comfortable and at ease, and how I could reword questions and ask follow-up questions to elicit more discussion from students. I also wrote similar notes in my journal during the interview transcription stage as I was reading and re-reading transcripts. During data interpretation, I continued to use my journal to reflect on my interpretation of participants’ experiences and the lens through which I was identifying patterns within the dataset, including what I may have been overlooking. Throughout the study, my entries in my reflexive journal informed my understanding of the data and added depth and transparency to the research process. While the journal entries informed my analysis and write up, the written entries in my journal were not formally transcribed or systemically analyzed. Ethical Considerations Prior to recruiting a school to participate or participants within the school, as well as participants within the school, ethical approval was obtained from the Behavioural Research Ethics Board (BREB) at the UBC. In addition, ethical approval was also obtained by the school district’s research ethics board and all procedures required by the school’s research ethics board, were followed. Informed consent detailing the purpose and outcomes of the study, the participant’s role, any potential consequences to participating, as well as confidentiality and its limits were explained in detail to each participant prior to scheduling the interview. It was also emphasized that participation was voluntary, and they could withdraw their consent at any time without repercussion up until the analysis of the data was completed. To ensure confidentiality for all 73 participants, each participant was given a pseudonym that was used throughout the completed written document. All electronic files that included participant data and confidential information were password protected. Electronic files were also stored on my graduate research lab’s One Drive, a secure cloud service provided by UBC. I also ensured that confidential information was not collected or exchanged via email unless it had been password protected. Participants had the option of completing their interview in-person or virtually over Zoom. While in-person interviews were audio recorded, Zoom interviews were video and audio recorded; however, participants were not obligated to turn on their camera if they did not feel comfortable. Participants were informed that that Zoom audio and video recordings would be stored on UBC’s licences Zoom cloud server. For students who were under the age of 16, consent was obtained by their parents and assent was obtained by the student. Mental health may be a deeply personal and sensitive topic for some participants and questions may elicit discussion about personal experiences in dealing with their own or others’ mental health challenges, which can be distressing. In the event that a student or parent participant required additional support, the researcher had compiled a list of local mental health resources in the community that participants could access. I was given consent by the administrators to attend SBRT and ESBRT meetings. Further, at the beginning of each meeting that I attended, I introduced myself and informed the staff who were present that I would be observing the meeting and re-iterated the purpose of my observations. I informed those present that I would be taking notes but that I was not recording identifying or confidential information about staff or students. Staff members were informed that they could let me or one of the administrators know if they were not comfortable with my presence at these meetings. 74 Data Analysis According to Merriam (1998), data analysis is “the process of making sense out of the data” (p. 178), which involves consolidating, reducing, and interpreting participants’ accounts that have been shared with me, the researcher. The current case study reflected an embedded single case study design. As a result, the data was analyzed between the subunits and across subunits to ultimately better understand the school (Baxter & Jack, 2010). Reflexive thematic analysis (reflexive TA; Braun & Clarke, 2022) was undertaken to analyze interview data in the current research study. According to Braun and Clarke, reflexivity is “the practice of critical reflection on your role as a researcher, and your research practice and process” (p. 5). It was important as the researcher to be critical and reflective about my assumptions and expectations of the research study, as well as the actions I took during the research process, the reasons I took them, and how each decision made impacted the study. Furthermore, it was essential for me to recognize and acknowledge that my own influence and subjectivity, shaped by my socio-demographic positioning, values, experiences, biases, and beliefs, impacted each stage of the research study, including my interactions with participants and my engagement with the data. Consistent with the underlying assumptions of reflexive TA, my subjectivity as the researcher was essential in shaping the research design, data collection and analysis, and outcomes of the study, which is viewed as a strength within reflexive TA. Aligning with a social constructionist perspective, reflexive TA is a method in which the researcher actively produces patterns or themes within data that are intended to either describe and/or interpret the particular data set (Braun & Clarke, 2022). My active role as the researcher was evident in my identification of themes and my choice and interest in which themes were selected and reported (Braun & Clarke, 2006). The themes are, in part, a product of my influence and subjectivity. Another major 75 strength of reflexive TA is its flexible approach to data analysis, as it can be used within any theoretical framework, to answer most types of research questions, and can be used to analyze different types of data, including those that were used in the present study (Braun & Clarke, 2013). Braun and Clarke (2022) outlined a six-phase process to be used as a guideline when using reflexive TA: (1) familiarizing yourself with your data, (2) generating codes, (3) generating initial themes, (4) developing and reviewing themes, (5) refining themes, and (6) producing the report. Braun and Clarke (2006) emphasized that writing up the findings is a significant component of the analysis and not just an activity that occurs at the end of the research process. Although the use of reflexive TA guides the researcher through a series of stages, Braun and Clarke (2022) cautioned that these stages are not intended to be interpreted as a set of rules that must be followed sequentially, but as guidelines. While the stages are presented in a specific order, the data analysis process is not linear, but iterative, in that movement between the different stages will inevitably occur as I moved between transcripts, as well as other data sources. The ultimate goal of reflexive TA as a data analysis method is to produce themes that capture the important and relevant elements of the dataset in order to tell its story. Stage 1: Familiarizing yourself with your data. The initial step of reflexive TA involved immersing myself, as the researcher, in the original data. Familiarizing myself with the data began when I started transcribing the interviews and continued as I read and re-read interview transcripts, as well as my observation notes and other important documents that I had collected. I recruited three graduate students to assist with transcription. They transcribed half of the transcripts. To transcribe the interviews, I uploaded the audio file of each interview to Microsoft Word on UBC’s OneDrive and used the transcribe function to generate an initial transcription. I 76 then listened to each interview as I reviewed and edited the initial transcription that was generated for accuracy and readability. I completed the second part of this process for the transcripts that were completed by the graduate students. Through this immersion, I came to know the data well, including the breadth and depth of its content. Beyond reading and re-reading data, I started to make sense and meaning from the data and recognize patterns and connections across the data set. Through transcription and repeated reading, I took notes to record my initial thoughts about the data and questions that emerged. I identified several aspects of the data that I wanted to explore and potentially analyze further. For example, I made notes asking about the role of the school in supporting student mental health and the fine line between being supportive versus overly accommodating to students. The process of familiarization with the data, including these notes and ideas, prepared me for the second phase of data analysis. Stage 2: Coding the data. Working systematically through the dataset, I began to code the data using physical/printed copies of each transcript. Braun and Clarke (2022) encouraged coding data in a way that works best for the researcher, whether that is electronically or manually. As a result, I elected to code my data manually using physical copies of each transcript rather than data analysis software as I process and retain information more easily and more in-depth when I have the physical copy in my hands (as opposed to reading on a screen) and I can freely highlight, underline, and write notes using a pen or pencil anywhere onto the printed transcripts. I also found that ideas and connections amongst the data were generated more easily when I could physically write them down on paper. I found this process allowed me to more easily engage with the data and move around from one transcript to another. Codes refer to “the most basic segment, or element, of the raw data or information that can be assessed in a meaningful way regardless of the phenomenon” (Boyatzis, 1998, p. 68). Braun and Clarke 77 (2022) referred to codes as the building blocks of themes. To create codes, I read through each interview and while doing so, I highlighted or underlined parts of the data that I found interesting and that were potentially relevant to the research question. I subsequently labeled each part of the dataset with a new or previously used/similarly worded code label. For example, “parent as advocate”, “self-care important for role”, and “IEPs are a starting point”. As recommended by Braun and Clarke (2022), I coded as many potential themes as possible and tried not to limit myself during this phase. Once I had coded each transcript, I transferred all of my codes to a Microsoft Word document to create a codebook, which involved a list of all of the codes that had been generated from the entire data set. I had generated 741 codes across the 22 interview transcripts. As I was coding by hand, codes may have been redundant or labeled differently but had similar meanings to another code. For every code, I also wrote the participants with whom it was associated in order to more easily be able to collect extracts to include in the written report. Stage 3: Generating initial themes. At this stage, I started to analyze the codes and group them together in the Microsoft Word document based on similar meanings that could represent themes. A theme is intended “to capture a wide range of data that are united by, and evidence, a shared idea” (Braun and Clarke, 2022, p.77). Given the number of codes I was working with, this was a lengthy and recursive process during which I reworked the code clusters several times (by copying and pasting codes to and from different groupings, as well as highlighting particular codes or groups of codes that stood out to me and/or were a pattern in the data set) to create coherent clusters that centered around a shared idea that had the potential to be a theme. This phase of the analysis concluded with the initial organization of candidate themes, and other groups of codes whose usefulness and relevance were still being questioned, as well as codes that had been discarded. For example, some of the initial themes included “Sense of 78 Community/School Connectedness,” “School Challenges,” “Teaching the Whole Child,” “Parent Involvement/Advocacy,” and “Short-Term vs. Long-Term Support.” Other groups of codes that were still being questioned included those labeled “barriers to accessing and receiving support,” “privacy,” and “communication.” Stage 4: Developing and reviewing themes. During this phase, I reviewed the candidate themes produced during Stage 3 in order to determine whether they were appropriate for and relevant to the research question. Using criteria delineated by Braun and Clarke (2022), I revised the candidate themes to ensure that each theme (including subthemes) consisted of a single shared idea with a central organizing concept that was distinctive, meaningful, comprehensive, and coherent, as well as important and relevant to the research question. This stage also involved returning to the codes in the Microsoft Word document and refining code clusters to ensure provisional themes were coherent, distinctive, and consisted of a central organizing concept. Furthermore, I wanted to ensure that I had sufficient data so that each theme/subtheme could stand on its own. At this stage, theme and subtheme names were further revised to reflect the shared idea. For example, subthemes included “Home-School Collaboration,” “Working as a Team,” and “Acknowledging Boundaries.” In developing and reviewing themes, this phase also involved discarding some of the initial themes all together, combining themes, or breaking some themes down into one or more themes, or sub and overarching themes. For example, I initially identified three subthemes within the theme, Supportive Psychosocial Climate, until I combined the subthemes related to relationships being foundational and school connectedness as participants seemed to discuss these topics together. In addition, “Parent Involvement/Advocacy” became part of a subtheme rather than its own subtheme. In the Microsoft Word document, I wrote notes/comments about moving around some of the code clusters or adding them to another 79 theme/subtheme. Once the themes had been revised and developed based on the outlined criteria, I returned to the full dataset to determine whether the themes created a cohesive and comprehensive story that represented the dataset and that ultimately answered the research question. It is particularly important within case study to always return to the broader data set or the larger unit of analysis, as a major pitfall of case study research is to focus solely on the embedded subunits. This phase concluded with the development of provisional themes that told a coherent, comprehensive, relevant, and important story about the dataset. Stage 5: Refining, defining and naming themes. During this phase, I further defined and refined the themes that were developed during the previous phase, which involved being able to articulate what each theme captured and to describe the scope and content of each theme within the data set. In addition, this phase involved creating theme names that were “informative, concise, and catchy” (Braun and Clarke, 2022, p.111). For example, theme names at this stage included: Supportive Social Climate, Availability of Supports, Approaches to Support, Role and Their Boundaries, and Challenges with Providing Support. I was still revising the name of the fifth theme. At this stage, I mapped out my themes and subthemes in a diagram/figure using Microsoft Word as a way to visually organize my themes at this point, which provided clarity and an overview of the story of how the school supported student mental health. I also found it helpful to write out my themes and subthemes using pen and paper where I was able to jot down notes about the content of each theme and subtheme. I then consulted and collaborated with a fellow doctoral student and researcher over Zoom to discuss the validity and structure of my themes, as well as the names. For example, I articulated to her the scope and content of the themes and subthemes I had identified at this point, posed questions about whether to combine certain subthemes, how to integrate contradictions into the dataset, and verified the cohesion and 80 comprehensiveness of my findings. Articulating the scope and content of my themes and subthemes aloud to another person also helped me to refine my themes and determine whether each theme was a distinct concept with sufficient evidence that fit within the larger dataset. Further changes were made to my themes at the conclusion of this meeting and before consulting with my research supervisor. With the help of the fellow doctoral student in our lab, we identified an overarching theme (“Encountering Challenges”), as well as six themes, and 17 subthemes. The fifth theme was named “Expectations Vs. Reality.” The names of themes and subthemes were further refined although there were theme and subtheme names that were still being questioned for their ability to capture the full context of the theme or subtheme. During the meeting with my supervisor, themes were discussed in great detail. While changes were not made following this meeting, questions about the names and structure of my themes were raised and we decided to return to some of these questions once I had written the findings. This phase of data analysis concluded with a set of provisional themes, including sub-themes and one overarching theme, that would be further refined during the report writing phase. Stage 6: Producing the report. Writing the report is considered another phase of the data analysis. The main goal of the write-up was to tell the story of the data in a way that was interesting, logical, coherent, and compelling. During this phase, I continued to refine the themes and their structure as I wrote the story of the data. Writing was helpful in clarifying theme names and the structure of themes and subthemes, including the boundaries and distinctiveness of the themes. In addition, feedback from my research supervisor was helpful in refining my themes. For example, while writing, at times it became clear if a subtheme was better suited within another theme or if subthemes overlapped based on the data extracts and the content and context of the data. During this phase, I made changes to the themes and subthemes within it. For 81 example, I discarded the overarching theme (“Encountering Challenges”) and combined two themes (“Expectations vs. Reality” and “Gaps in Mental Health Support”) as I realized as I was writing that there was redundancy across these themes and the boundaries of each theme were unclear. During this process of combining both themes, I discarded a subtheme as I did not find it relevant to the research question nor was it cohesive with the larger dataset. I also combined two subthemes as I discovered significant overlap while writing my findings. Even at this final stage, it was a recursive process that involved returning to prior stages of data analysis. The write-up of my findings involved carefully chosen extracts from participants that supported each theme. Braun and Clarke (2022) emphasized that the write-up is not solely a description of the data involving paraphrased extracts. It was my responsibility to go beyond description and interpret the data by explaining its meaning and reasons why the data is important and how it answers the research question. Research Quality Overview I ensured quality had been integrated throughout the present research study by primarily following Tracy’s (2010) eight criteria for excellent qualitative research, including having a worthy topic, engaging in rich rigour, being sincere, ensuring credibility and resonance, making a significant contribution, being ethical, and ensuring meaningful coherence. In addition, I followed Braun and Clarke’s (2022) considerations for ensuring quality, including keeping a reflexive journal, consulting with others, being selective with naming themes, drawing inspiration from published material, and keeping an audit trail. Worthy Topic According to Tracy (2010), a worthy topic refers to research that is relevant, timely, 82 significant, interesting, or evocative. As a significant number of adolescents are struggling with their mental health, the exploration of available supports within the school setting was considered relevant, timely, significant, and interesting, particularly because schools have been recognized as primary institutions that can provide support to youth struggling with their mental health. In addition, provincial and school district policies and practices are intended to support those with special needs. It is, therefore, important to explore how a secondary school is supporting its most vulnerable students and to obtain the multiple perspectives of those involved in receiving and providing that support. Rich Rigour Rigour refers to the extent to which the study is thorough and requires an in-depth engagement with the topic (Tracy, 2010). Rich rigour was implemented at every stage of the study. I ensured that my qualitative study was rigorous by investing sufficient time, effort, and attention at the secondary school and with participants to ensure that I collected a sufficient amount of data that provided rich description and content. In the process of data collection, I discussed with my research committee to confirm that a sufficient amount of rich data was collected. Another indicator of rich rigour is ensuring that the sample is appropriate for the purpose of the study. As the purpose of this study was to better understand how stakeholders within a secondary school supported students experiencing mental health difficulties, my sample included members of varying roles within the school community, including students, parents, teachers, educational assistants, mental health professionals, and administrators. My approach to data collection, which included semi-structured interviews, observations, and document reviews, was appropriate for a case study methodology. Finally, reflexive thematic analysis is an appropriate and cohesive method of data analysis for semi-structured interviews. 83 Sincerity At the outset of the present study, I was transparent about my position and role in the research process to my committee members and to my participants. It was essential for me not only to identify and disclose my own philosophical positioning when conducting research, but also my own personal experiences, values, beliefs, and assumptions that may influence the research process and how the resulting data were collected and analyzed. In alignment with reflexive TA, I continued to be reflexive about my values, beliefs, and biases throughout the research process by keeping a reflexive journal. I wrote in my reflexive journal at each stage of the research process, particularly following interviews with participants, while transcribing the interviews, and throughout the six-phase data analysis process. My reflexive journal provided a space in which I could express my thoughts and reflect upon not only the data, but also my influence on and engagement with the collection and interpretation of the data. As discussed by Braun and Clarke (2022), I also used my reflexive journal as a tool to challenge the ways in which I engaged with, interacted with, and responded to the data. An audit trail was another tool I used to ensure transparency, as it provided a clear description of each stage of the research process (Braun & Clarke, 2022; Yardley, 2000). An audit trail consisted of keeping notes throughout the research process, particularly from discussions with my research supervisor or committee when rationalizing decisions throughout the process. Further, as described by Braun and Clarke (2022), I kept paper and/or electronic copies of coded data items, lists of codes, and iterations of my themes as handwritten or digital visuals. In addition, I was transparent with my research supervisor and other committee members about any challenges that arose throughout the research project and how they were ultimately resolved. 84 Credibility Credibility refers to the trustworthiness, plausibility, and authenticity of the case study findings. To achieve credibility, I had ongoing contact with the vice-principal and spent time within the school recruiting participants, completing interviews, attending school-based team meetings, and making observations. I used rich and thick descriptions and explanations within my written document that were situated within a well-described context, a component that is inherent to a case study. As multiple sources of data were collected, triangulation was used, when possible or applicable, to converge information regarding the phenomenon being studied from different sources (e.g., comparing perspectives and experiences of various stakeholders). Drawing upon Birt and colleagues’ (2016) method of member checking, synthesized member checking, attempts to enhance credibility were also made by electronically sending each participant their password-protected transcript to review for accuracy as well as the preliminary findings describing the themes that I had identified from analyzing the interviews using reflexive thematic analysis. With their transcript, I gave participants the opportunity to make clarifications as well as add any comments or further information to their original transcript. Five participants replied to my email and none of them made any changes. I sent participants the preliminary findings to receive their feedback about my interpretation of the data, particularly regarding to what extent the findings resonated with their own perceptions and experiences regarding how students experiencing mental health difficulties were supported at school. Four participants replied to my email, all of whom contributed positive feedback about the findings. The case study was also multivocal by involving multiple stakeholders including students, parents, teachers, school counsellors and the school psychologist, as well as school administrators. Lastly, my reflexive journal provided me with a space to recognize and critically think about my 85 assumptions, interpretations, and biases and their influence on the study. Resonance Resonance refers to the extent that the research resonates and has an impact on its audience. One component of resonance is the transferability that can be made from the knowledge and conclusions resulting from the research (Tracy, 2010). While the transferability of research findings is based on the reader’s judgment and ultimately their decision whether the findings are transferable to their own context, it is my responsibility to provide sufficient contextual information about the study (e.g., participants, the school, school district; Braun & Clarke, 2022). While making a considerable effort to maintain the school’s anonymity, I tried to provide as much detailed information about the school and those who participated, as well as the school’s practices towards supporting student mental health, in order to maximize the potential for transferability of the findings to the reader’s own setting and circumstance. In addition to some demographic information, I described the services related to mental health support provided within the school, as well as within the school district. Additionally, Chapter 4 describes contextual information not solely pertaining to the school itself but information regarding district- and provincial-level influences of school-based mental health support. Furthermore, my literature review situates this case study within the current state of youth mental health, particularly within the province of BC. Providing this broader contextual picture enhances the potential for transferability. Transferability was also enhanced by having a secondary school that was considered relatively typical and potentially representative of other secondary schools in the school district or possibly Lower Mainland (Merriam, 1998). It is my hope that the research findings from this case study, including the school’s strengths and limitations, can be valuable to the school itself, but potentially also to other secondary schools in 86 the school district, despite some of the characteristics that differentiate this school from others within the district (i.e., its size). Various factors that limited transferability are discussed in the Limitations section in Chapter 6 of this document. Significant Contribution The goal for this case study was to make a significant contribution to the field of adolescent mental health and school-based mental health, and to contribute to the Canadian literature in these areas. The findings are practically significant to the secondary school, as the research explored the ways in which the school supported its students’ mental health. This research highlighted all of the ways in which the school was currently supporting students who experienced mental health difficulties and where improvements could be made to its practices and overall climate. It was evident that the school also faced many systemic barriers in its provision of support. Obtaining the perspectives of multiple stakeholders provided a holistic understanding of this phenomenon that can be valuable to the school. In addition, this case study can have methodological significance by advancing the use of case study research in the field of education and mental health. Ethical As the researcher, it is important to be ethical and “mindful of [our] character, actions, and consequences on others” (Tracy, 2010, p. 847). Ethical requirements mandated by UBC’s and by the school district’s research ethics boards were followed. Ethical practices were followed, and ethical decisions were made throughout the research process. In terms of relational ethics, I was reflexive of my own positioning as the researcher and was mindful of the power dynamic that could arise between myself and the participant. I also approached my interactions with the case and with participants with mutual respect, dignity, care, and compassion. I placed 87 great value on and was unbelievably grateful for the relationships I developed and the collaboration with others, particularly the school’s vice-principal, but also with each student, parent, teacher, educational assistant, school counsellor, school psychologist, youth engagement worker, and school administrator that took place throughout the research process. I continued to be an ethical researcher once data collection was completed and was mindful about how the research was presented. Meaningful Coherence Meaningful coherence was achieved by ensuring that the components of my case study were logical and consistent with one another, and the final product achieved its stated purpose set out in this proposal. Additional Strategies to Ensure Quality As outlined by Braun and Clarke (2022), another strategy for ensuring quality when conducting qualitative research and specifically reflexive TA is to consult and collaborate with others about my data. I found it tremendously helpful to collaborate with my research supervisor during each stage of the process to discuss issues that arose during the research process, including questions or changes that I wanted to make to my original proposal based on the data I had collected and my interpretation. As recommended by Braun and Clarke (2022) to ensure quality, I worked closely with my research supervisor, who is an experienced research supervisor for both quantitative and qualitative research. My research supervisor was a valuable sounding board for my initial analytic insights and provided me with thoughtful discussion and feedback. She also challenged and critiqued my work. At the theme development and review stage of my data analysis, I collaborated with a fellow doctoral student and researcher, who was familiar with my research study, as well as with my research supervisor. Having the ability to discuss my 88 thematic map and explain the rationale of my initial themes was very beneficial, as it allowed me to further define each theme and recognize each theme’s place in the overall story of my data. These meetings also prompted interesting discussions about the data, which gave me the opportunity to clarify and gain new insights regarding the data and theme development. These meetings also led to further changes in my analysis and refinement of my themes, including keeping or discarding a theme or subtheme, reorganizing the thematic map when subthemes did not appear to fit under initial themes, and allowed me to reconsider at times the boundaries of my developed themes and subthemes. I went through several iterations of theme development. Carefully selecting theme names is another one of Braun and Clarke’s (2022) strategies for ensuring quality research. During my meetings with the fellow doctoral student and my research supervisor, I received support and insight that enabled me to identify and refine my theme names. Further, my research supervisor’s feedback and edits were instrumental in finalizing the written report and also helped to further refine my data analysis. Finally, as per Braun and Clarke’s final strategy, I turned to other students’ published dissertations that exemplified the use of reflexive thematic analysis, as well as to case study methodology, to gain a better understanding of how to produce a well written, coherent, and concise document involving this methodology. Chapter Summary In this chapter, this study’s case study design was described, including its epistemological and theoretical underpinnings. The boundaries of the current case study were also explained. Procedures for data collection, including school and participant selection and recruitment methods, participant characteristics, and the measures used to collect data were described. Ethical considerations, including participant informed consent and assent, as well as 89 confidentiality, were outlined. Interview data analysis, which involved Braun and Clarke’s six-phase reflexive TA, was described in detail, as were the steps taken to ensure high-quality research. 90 Chapter 4: Context Overview The context in which a case is situated is a fundamental characteristic of a case study. The case in the present study is a secondary school and the phenomenon that was studied involved an exploration of how the key stakeholders within the school supported students who struggled with their mental health. While the case was bounded by the school’s immediate environment (i.e., that which took place within the physical building of the school), the school was situated within a complex system of various environmental factors that influenced the availability and provision of support to students, and equally important, created and contributed to the barriers and challenges involved. As a result, and consistent with case study methodology, it is essential to describe the different elements that impacted the school’s provision of supports in order to provide a complete understanding of the school’s support. Bronfenbrenner’s ecological systems model (1979, 1994) was used as an organizational framework to demonstrate and describe the contextual layers that influenced the support provided to students. Although considerations were made to apply Bronfenbrenner’s model as a framework throughout this written document, including the literature review, findings, and discussion sections, it was ultimately decided to solely use Bronfenbrenner’s model to illustrate these contextual influences surrounding school-based mental health support in order to achieve conceptual and structural consistency throughout the document. The following section outlines the context surrounding the school. As there are an enormous number of factors that may impact the support that is provided to students struggling with their mental health at school, the following section is not intended to be an exhaustive picture, but highlights some of the relevant contextual factors that particularly influenced the school environment. 91 Microsystem and Mesosystem Overview The previous chapter provided a brief description of the school and the services it offered to support students struggling with mental health difficulties, which represented environments within the microsystem. In addition, students’ family or home life is another important environment within the microsystem that influences students’ wellbeing. While parents were involved in the current study, students’ home or family were not primary settings of investigation and information about this particular environment was not collected directly. On the other hand, parents themselves are represented within the mesosystem of the framework, specifically, around the collaboration between home and school to support students struggling with mental health challenges. The current study focused on the school environment within the microsystem and the home-school relationship located within the mesosystem to explore the support provided to students within this particular school (i.e., the bounded case). Drawing from Cross and Hong’s (2012) application of Bronfenbrenner’s framework to the school context and as evident in the findings that resulted from the thematic analysis, the impactful support that was provided to students was primarily a result of the reciprocal relationships that occurred between students and individuals within the school, including teachers and educational assistants, mental health professionals, and administrators (as well as with their parents). The mesosystem also encompassed the partnerships between community mental health services or mental health professionals within the community and the school, as well as with parents. Although school personnel briefly discussed or touched upon their role in referring students to and collaborating with mental healthcare providers in the community, these professionals were not involved in the study. 92 School-Based Context Overview. School-based support services across the district included learning and counselling services, as well as those provided by a school psychologist. Each secondary school also had the Pathways program and as per the Ministry of Education guidelines (2016), students were also supported through the SBRT and ESBRT. According to the school’s district inclusive education handbook4(2020), the school district had a four-level inclusive education service delivery model that outlined learning support for students with academic challenges as well as support services for students with behaviour or mental health challenges. The level of support increased from Level 1 to 4. At Level 1 for students struggling with their mental health, intervention involved collaboration between the classroom teacher, parent/caregiver, and the student. At this level, consultation amongst school staff occurred if needed to identify adaptations that may have been effective for the student. The teacher, parent, and student developed a support plan and timeline to review the effectiveness of the identified adaptations. If intervention at Level 1 was not sufficient in meeting the student’s needs, Level 2 involved a discussion of the student at an SBRT meeting. At this level, students may have also received additional support through connecting with the counsellor, youth engagement worker, educational assistant, etc. If the student continued to need support, Level 3 involved a discussion about the student at the ESBRT, including applying for a Ministry of Education special education designation (Category R or H). The student may also have been connected to the school psychologist, counsellor, or another mental health service in the community. Finally, if a student’s needs were not being met at Level 3, Level 4, which involved the most intensive supports, involved a referral to the District Resource Team (DRT). The DRT involved members 4 To protect the school’s identity, information obtained from the school district’s website and documents were kept anonymous. 93 of the school’s ESBRT as well as members of the district learning services team and representatives from community agencies. At this level, considerations were made about the appropriateness of a referral to an alternate program, such as the alternate education secondary school within the district. Counselling Services. The school typically had two counsellors that worked directly with students. According to the school district’s inclusive education handbook, counsellors provided individual and group services for students with academic, social, emotional, behavioural, and mental health concerns, particularly when they interfered with students’ academic functioning. They also provided educational planning and career counselling. As part of their role, counsellors had a range of responsibilities including but not limited to communicating, consulting, and collaborating with parents and other school staff; and serving as case managers for students with R and/or H designations and being part of the process of creating and reviewing students’ IEPs. They also collaborated with community agencies to support students. For students struggling with their mental health in particular, school counsellors were integral to supporting students at each level of the district’s service delivery model (School District’s Inclusive Education Handbook, 2020). School Psychology Services. According to the school district’s special education learning services handbook (2020), the role of the school psychologist was to collaborate and consult with school staff to support students with diverse learning profiles, including students with mental health difficulties. The school psychologist attended the ESBRT meetings that occurred bi-weekly. Part of school psychologists’ consultative role was supporting the school to determine the students who would benefit most from a psychoeducational assessment and completing these assessments with students. As part of these assessments, the student’s social, 94 emotional, and behavioural functioning was also often assessed. The school psychologist also provided recommendations regarding students’ educational programming, as well as adaptations, modifications, or other instructional strategies to support students’ academic performance and social, emotional, and behavioural functioning. The school psychologists in this district did not typically provide direct mental health intervention to students. Pathways Program. Pathways was a school-based program located in each secondary school in the school district. It was intended to provide additional services for students who were struggling with social, emotional, and/or behavioural concerns that were impacting their academic progress. Pathways was an inclusive education program as a key benefit of Pathways was that it allowed students to remain in and maintain connections within their neighbourhood school as opposed to receiving services at the district’s alternate education secondary school. The Pathways team at the school that was the focus of this case study consisted of the Pathways teacher, a school counsellor, and the youth engagement worker. As per the school district’s inclusive education handbook (2020), the Pathways team’s role was to provide students with social, emotional, and academic support; IEP development; collaboration with other school and district staff, parents, and students; collaboration and coordination with outside agencies; and supporting teachers with curriculum adaptation for students, if necessary, among many others. In addition, the Pathways team played a major role in advocating for students’ needs and flexible support based on their unique needs. Furthermore, the team provided behavioural support for students whose mental health challenges were interfering with their ability to attend school. According to the Pathways handbook (2016), the program provided support to students at three different tiers. Each tier of the model involved progress monitoring of students’ social, emotional, behavioural and academic development, as well as collaboration with classroom 95 teachers surrounding adaptations to the curriculum. At Tier 1, students remained enrolled in their regular classrooms, but were also connected to the Pathways team through regular check-ins. Much like Tier 1, students who were enrolled in Tier 2 remained in mainstream classes. At this level, students could access the Pathways classroom. Tier 3 was the most intensive level of support. Students at this tier had an individualized program that was case managed by the Pathways team. Classroom teachers and the Pathways team continued to collaboratively support students in coordination with community supports, if necessary. In addition, students regularly received individual counselling services with the school counsellor who was part of the Pathways team. The Exosystem Overview The exosystem involves settings with which students do not directly interact but nevertheless influence school-based support. Beyond the microsystem and mesosystem, there are several institutions within the exosystem that influence school-based support for students struggling with their mental health including the school district, the local mental health agencies, as well as the provincial and federal governments. School District Overview. The school district, which is public, is located within the Lower Mainland of British Columbia. At the time of the study, there were over 17,000 students and 2,600 staff within the district. There were 25 elementary schools, seven secondary schools (including an alternate education secondary school), and an online learning program that students could access. The student body was described as diverse according to the district’s most recent Student Learning Report (2024). Three percent of students self-identified as Indigenous, 15% of students 96 were those with special needs, 11% were considered English Language Learners and about 25% of students came from 120 different countries around the world. Beyond the Pathways program, the school district had an alternate education secondary school as well as programs within or connected to this school that were specifically designed to support students who may have had social, emotional, and/or behaviour challenges. Furthermore, the school district had departments that influenced and/or directly impacted the support that was provided to students at the secondary school that was the focus of this case study. Alternate Education Secondary School. Once school-based services at a student’s neighbourhood school had been exhausted and a student required additional support as a result of ongoing social, emotional, and behavioural difficulties that impacted the student’s learning, secondary schools, such as the school that was the focus of this case study, could refer students to the district’s alternate education secondary school. Consistent with BC’s Ministry of Education policy on alternate education programs (2009), the alternate education school offered intensive support “through differentiated instruction, personalized program delivery, enhanced counselling and integrated community services” (School District, 2020, p.89). Given the profile of students who attended the alternate education secondary school, the school had established partnerships with community and ministry agencies, such as the Ministry of Children and Family Development and Vancouver Coastal Health, who offered additional and more intensive services and programs based on each student’s individual needs. Each program catered to the varying needs of students who had traditionally not been able to engage in or be successful with the academic and behavioural expectations of their neighbourhood schools. In addition to focusing on students’ academic development, these programs offered students opportunities to participate in recreational and experiential activities that took place outside the classroom and/or school. 97 Further, each of these programs aimed to develop clinical or life skills to either manage symptoms related to mental health difficulties, as well as develop self-esteem, communication and independent skills. Safe and Caring Schools. Safe and Caring Schools was a district-level department that ensured that students were learning in a safe and nurturing environment, which provided the basis for supporting students’ mental health and well-being (School District, n.d.). The school district created its own eight-component guide to achieve their mission of providing safe and caring schools (School District, n.d.). The eight components included a positive school climate, code of conduct and administrative procedures, violence prevention curriculum, emergency management, community support, intervention strategies and behaviour management, student empowerment, and site security (School District, n.d.). Social Emotional Learning (SEL). The school district prioritized the development of students’ Social Emotional Learning (SEL) and mental health through its continuum of SEL supports (School District, 2019). Created by the school district, the continuum was composed of four key areas of SEL that each school was intended to prioritize to meet the social-emotional needs of its students including cultivating a sense of belonging for students, teaching social emotional skills and creating healthy and supportive learning environments using the Collaborative for Academic, Social, and Emotional Learning (CASEL) Framework, developing students’ mental health literacy through Dr. Stan Kutcher’s curriculum, and providing an Integrated Service Approach to Mental Health supports (School District, 2019). In the first SEL area, the school district strove to cultivate a sense of belonging for students and staff members through the development and strengthening of relationships and connections within each school community (School District, 2019). Second, the school district 98 used the CASEL framework to teach social emotional skills, as well as to develop supportive classrooms and overall school climates to enhance students’ social, emotional, and academic development (School District, 2019). At the school level, the school implemented CASEL’s indicators of schoolwide SEL (e.g., SEL integrated instruction, supportive discipline, authentic family partnerships) to measure the extent to which they were integrating SEL throughout the school’s culture. For example, during the vice-principal’s interview, she noted that to address supportive discipline, school staff interpreted behaviour from a developmental lens and try to address the function of a student’s behaviour rather than resorting to harsh punishments. The school used CASEL’s self-rating system to measure the extent to which they were following these indicators. Mental health literacy was another area of SEL support on the district’s continuum. To enhance students’ mental health literacy, the school district had integrated The Mental Health and High School Curriculum Guide (the Guide) that was created by Drs. Stan Kutcher and Yifeng Wei into the Grade 9 Physical Education curriculum. The evidence-based Guide is a comprehensive supplemental tool to be used in classrooms that teaches students about various mental health disorders in order to be able to recognize and prevent symptoms, and to seek help when they do occur (Kutcher & Wei, 2017; Kutcher et al., 2015; Milin et al., 2016). The final component of the district’s continuum, integrated mental health supports, involved collaborating with community agencies to provide wraparound support to students with mental health needs, which also involved the Pathways program and the alternate education secondary school. Local Community Agencies The school that served as the case for this study and school district had created 99 partnerships with community mental health agencies and supports5, including provincial services such as Foundry and Child and Youth Mental Health (CYMH), as well as local hospital programs for youth mental health. Foundry and CYMH are both agencies with locations across the province that offer free mental health services to youth. In addition to mental health services, Foundry offers substance use support, primary care, peer support and social services to youth and young adults aged 12 to 24 (Foundry, n.d.). CYMH also offers individual and group therapy, mental health assessment, access to a psychiatrist, and coordination with other professionals involved in the student’s care. Students could access CYMH services by attending their intake clinics and they could access Foundry by attending their drop-in counselling and primary care hours. The availability of these supports could lessen the burden on schools as the primary setting in which adolescents and their families could access support; however, the availability of these supports was dependent on provincial funding and resource allocation. It is unclear the extent to which these community supports were effectively lessening the burden on the school. The limitations of these community supports, including long waitlists, limited access to trained mental health professionals, including psychiatry services, and dysfunctional service delivery models are discussed in the next chapter. Provincial Context At the provincial level, the Ministry of Education and Child Care, formerly known as the Ministry of Education prior to 2022, was the primary governing body that made decisions that determined how well schools were equipped to support students’ mental health needs. For example, the Ministry of Education and Child Care allocated funding and resources to school districts across the province, created and implemented policies and guidelines regarding special 5 The names of additional community supports are not provided to protect the school’s anonymity. 100 education services (described in Chapter 2), developed the education curriculum for students across the province, and developed and implemented school-based mental health strategies and initiatives, including the MHiS Strategy. The extent to which the Ministry of Education and Child Care prioritizes student mental health and well-being impacts a school district’s provision of supports to students experiencing mental health challenges. Funding decisions made by the Ministry of Education and Child Care impacted the school district’s resources, including the number of mental health professionals or other specialized staff that are available to support struggling students, as well as specialized programs offered by the school district including Pathways and the alternate education secondary school. In addition to the Ministry of Education and Child Care, the Ministry of Children and Family Development was also responsible for funding local mental health agencies including CYMH and, in part, Foundry. Beyond initiatives that address youth mental health and well-being within the school context, the province demonstrated its commitment to prioritizing youth mental health through other plans and strategies, including A Pathway to Hope: A roadmap for making mental health and addictions care better for people in British Columbia (2019). This document highlighted the need to improve the wellness of youth through the expansion and establishment of community mental health services such as Foundry and Integrated Child and Youth (ICY) teams. As part of the vision to improve youth mental health within the province (2019), addressing and supporting mental health in schools was another identified area in which youth wellness could be improved. Since 2019, there have been some developments within the province towards increasing mental health services in communities and in schools. In the most recent A Pathway to Hope Progress Report (2023), the report highlighted the provision of $3.6 million in mental health grants to the development and promotion of school-based mental health, as well as the successful continuation 101 of Everyday Anxiety Strategies for Educators (EASE), a classroom curriculum for teaching students about how to cope with anxiety. Progress was also made for mental health services in communities, including the addition of Foundry centres across the province as well as Foundry virtual services. Additionally, ICY teams had been implemented in five communities across BC and continue to expand to seven other communities in the province (Pandey-Kanaan, 2024). Situated within school district catchments, ICY teams provide support to children and youth struggling with mental health difficulties or substance use. Together, these provincial efforts and commitments towards addressing and improving youth mental health positively influence the support that is provided to students in schools. While it is beneficial that steps are being taken to expand mental health services for youth across the province, there continue to be significant barriers for children and youth experiencing mental health challenges to access appropriate services including long waitlists due to the increasing mental health needs of youth and a lack of mental health professionals to provide that support. Federal Context Similar to the provincial influence on student support for mental health difficulties in schools, the federal government can also have some influence, although more indirectly and from a greater distance, on school-based mental health support. Canada’s universal healthcare system can have implications for the availability and accessibility of mental health supports for adolescents in the community, which can have implications for schools in trying to support students struggling with their mental health. For example, the Canada Health Act, which was established in 1984, is the federal law that outlines Canada’s universal healthcare system, including what actions provinces need to take in order to receive federal funding (Canadian Mental Health Association, 2024). Recent criticisms of the Canada Health Act, particularly 102 following the COVID-19 pandemic, highlighted the lack of attention to mental healthcare, which caused barriers for Canadians to access mental health support (Canadian Mental Health Association, 2024). For example, not prioritizing mental healthcare sends a strong message that mental health is not as important as other health concerns, mental health services are often costly, and provinces do not allocate the same amount of funding to mental healthcare as they do physical healthcare (Canadian Mental Health Association, 2024). Broadly, the implications of the Canada Health Act may play a role in creating barriers for adolescents to access mental health services in the community. In addition, decisions made at the federal level can play a significant role in determining whether funding is allocated towards mental health initiatives and programs, or federal campaigns that raise awareness and educate the Canadian population about mental health. For example, the Canadian government recently created the Youth Mental Health Fund as a way to invest in the mental health of Canadian young people (Government of Canada, 2025). The Fund is intended to support and enhance community-based mental health services for youth. Providence Health Care in British Columbia was chosen as one of the first six projects to receive funding from the Youth Mental Health Fund. The funding is going towards the expansion of Foundry locations across the province, particularly to under-served communities (Government of Canada, 2025). Macrosystem Within the context of this case, the macrosystem represented the ways in which the broader culture in society surrounding mental health and illness and mental health support influenced school-based support for students struggling with mental health difficulties. This school was situated within a Western culture that has significant implications for how mental illness is perceived, diagnosed, and supported. For example, to have received support at school 103 through an H designation, which identified a student as requiring intensive behaviour intervention or with a serious mental illness, the student required a diagnosis of a mental health condition and support from an outside agency, which could serve as a barrier to receiving that level of support in the school setting. The culture that we live in shapes our beliefs, attitudes, and perceptions around mental illness and how we treat (both clinically and non-clinically) individuals who experience mental illness. Our culture also contributes to the stigmatizing attitudes, beliefs, and actions towards those who experience mental health conditions. Within the school environment, stigma towards mental illness, which was reported by some participants in the present study as being present amongst students and staff, could prevent students from seeking support (Gulliver et al., 2010), and could impact a student’s opportunity to receive support. It is important to note that, within our culture, there has been progress towards raising awareness, distributing knowledge, and reducing stigma towards mental health and illness. While still a sensitive topic, it has increasingly become a topic that individuals, including public figures, are more comfortable discussing, which helps to reduce stigma and isolation of those who feel alone. The perceptions around mental health and illness are shifting and with that, treatment options are becoming more accepted and available to those in need, including within the school setting. Chronosystem The chronosystem encompasses changes that have occurred over time that have impacted school-based support for students struggling with their mental health. The progress and efforts that had been made within our culture toward a better understanding towards mental health conditions as a result of the efforts made within the macrosystem had a major influence on how students were supported at school. Our increased understanding and knowledge of mental health 104 conditions and appropriate treatments resulted, in part, from the abundance of research in this area that occurred over time. The changes that have been made to support students at school are a reflection of the increased attention towards youth mental health, the significant research findings that shed light on students’ needs and appropriate support, and the cultural progress in society. For example, the development and implementation of programs such as Pathways, as well as alternate education secondary schools that were specifically intended to support students struggling with social, emotional, and behavioural challenges, were the result of an increased understanding of how these students struggle and how to provide supports that meet their needs in order for them to be successful. A major recent historical event that brought even closer attention to youth mental health and support is the COVID-19 pandemic. Research in this area highlighted the impact of the social consequences (e.g., self-isolation, social distancing, school closures, closures of other social settings) on the mental health of adolescents (Mental Health Commission of Canada, 2020) and the need to address these concerns and increase the availability and accessibility of supports for this population, including within the school community (Mental Health Commission of Canada, 2020). Chapter Summary Given the emphasis of context within a case study, this chapter outlined the various environmental factors that influence the support provided to students at school experiencing mental health difficulties. These identified environmental factors that are relevant to the provision of mental health support at school were organized into the nested layers outlined in Bronfenbrenner’s Ecological Systems model (1979, 1994), including the microsystem (i.e., the school), mesosystem (e.g., home-school relationship, relationship between the school and 105 community resources), exosystem (i.e., school district, local community agencies, provincial and federal factors), macrosystem, and the chronosystem. 106 Chapter 5: Findings Overview The purpose of this research was to gain a better understanding of the ways in which those within a secondary school community supported students experiencing mental health difficulties. Using case study methodology, interviews with 22 individuals within a secondary school community and observational data from SBRT meetings were analyzed using Braun and Clarke’s (2022) reflexive TA. In this chapter, the findings resulting from this analysis are presented. While other levels of Bronfenbrenner’s Ecological Systems model are important context, study data focused exclusively at the microsystem level, specifically the school. Through analyzing the data, I identified five themes and 16 subthemes (Figure 2) that provided an understanding of how students’ mental health was supported within the school, as well as the challenges that were encountered by the school that impacted the provision of supports. As my reflexive journal was a source of data, I integrated three excerpts from my journal into this chapter that pertained to my interpretation and thought process of specific findings. 107 Figure 2 Identified Themes and Subthemes Addressing How Students with Mental Health Challenges Are Supported at School Supportive Psychosocial ClimateRelationships are Foundational and Build ConnectionCreating Safe EnvironmentsAvailability of SupportsUnderstanding Adults and Flexible PracticesIEP as a Communication ToolPathways is a "Game Changer"Approaches to SupportSupporting the Whole Child Advocating on the Student's BehalfCollaborating as a TeamAcknowledging BoundariesThe School's Role"I'm Not a Counsellor"Parents Finding Balance in Their RoleChallenges To Providing Mental Health SupportSystemic BarriersLimitations of IEPs and AccommodationsImpact of Increasing Mental Health Needs in the ClassroomMental Health Education Lacks MeaningMeeting the Needs of Parents 108 Study Themes and Subthemes Theme 1: Supportive Psychosocial Climate Theme 1 Overview. The first theme represents the ways in which the school supported student mental health through cultivating a supportive psychosocial climate. The psychosocial climate refers to the aspects of the school environment that have an impact on students’ mental health. As such, this theme reflects how the school cultivated a supportive social climate through developing interpersonal relationships, which in turn nurtured students’ connections to the school community and ensured the physical, emotional, and psychological safety of its students. A supportive school climate aims to support the mental health of all students, including those with mental health concerns. All participants described the school’s climate favorably and discussed aspects of the school climate that support student mental health, particularly through the development of relationships, the sense of community within the school, and the safety of the environment. Within this theme, two subthemes were identified: 1) Relationships Are Foundational and Build Connection and 2) Creating Safe Environments. Reflexive Journal Entry. “A theme around school climate is definitely something I am immediately noticing across the dataset. A lot of participants, particularly educators, talked about building relationships and connections with students. I was a bit surprised by how school personnel talked about relationships with students and the sense of community within the school as an immediate response to how they support student mental health (as opposed to jumping to supporting them through their IEP, for example). I also want to be careful that I am not imposing my knowledge of the importance of school climate onto the data set, but given how much relationships in particular were discussed, I don’t think that is the case here.” 109 Subtheme One: Relationships Are Foundational and Build Connection. Meaningful connections amongst people within a school contribute to a supportive social climate. The subtheme of Relationships Are Foundational and Build Connection refers to the importance of students having connections with others in the building, including other adults and their peers. Many adult participants discussed how cultivating relationships with students created the necessary foundation for supporting student mental health and wellbeing. One general education teacher, Olivia, referenced Rita Pearson’s TED Talk titled, “Every Kid Needs a Champion” and related: [Building relationships with students] pretty much sums up my philosophy as a teacher which is relationships, is feeling like [students] can bring something to the table, even if they are not super academic or they're not super social, or if they are super social and you know, I think, yeah, to be recognized for being unique and individual, I think is really important. Parents also acknowledged the role of relationships for mental health support, with one parent describing adult-student relationships as being a “preventative measure” to support student mental health. In addition, several school personnel described relationship building as integral to their role or, as one general education teacher, Dan, put it, as encompassing “half the job [of a teacher].” A similar sentiment about the fundamental role of building relationships with students was shared by an EA, Victoria, who stated, “it's like everything, I find, it's huge, I don't think you can do this job without really getting a solid, strong relationship with the student.” School personnel conveyed a genuine interest in wanting to develop connections with students, and also conveyed that they care about the mental health and success of students. Teachers, EAs, and administrators described developing relationships with students through 110 “consistent, meaningful interactions” and through the use of personal experience to relate to students and build connection. Thomas, one of the counsellors, also emphasized the importance of building trust with students, describing it as “foundational” to his relationships with students, particularly in his role. To build connections with and between students, Hannah, the special education teacher, explained how she does a classroom check-in with students at the beginning of class. In addition, school personnel often expressed an understanding of the importance of student-teacher relationships by acknowledging these connections as a necessity for students when it comes to supporting their mental health. Dan, a general education teacher, articulated how every adolescent needs a caring adult in their life or at school with whom they can talk to: I think any young person needs somebody who they feel actually cares about them. So they need that relationship and there also needs to be a safe place where you can eat and just be safe and not have your guard up…but also to know that there's somebody in that building that cares about you, or that you can talk to and will either refer you to somebody else or will, and you can have a conversation with. Having a relationship with your teacher made it easier for some students, particularly those with anxiety, to advocate for or seek out support. For example, students may have felt more comfortable talking about mental health difficulties to a teacher with whom they had a connection or to approach a teacher to request accommodations such as an extension for an assignment due to being unable to complete the assignment as a result of mental health difficulties. The value of connections with adults did not go unnoticed by students, either, and they also expressed feeling cared about by their teachers. Several students commented on the particular teachers with whom they considered a trusted adult within the school, including the 111 music teachers, their case manager, counsellors, the youth engagement worker, and the Pathways program teacher. In describing the aspect of her support that she finds particularly helpful, one special education student, Lucy, commented on the impact of the connections she had made with certain adults in the school: I think like a personal level connection is really nice because I have that connection with [teacher] and with [mental health professional] and just like getting to know them and them getting to know me is really, it's really nice. Similarly, Diane, whose son received special education services at school, described the impact of support provided by her son’s connection to his music teachers, “I think the biggest supports he has are the music teachers who just are real boosters and, and constantly keep him feeling valued and needed and integrated into communities.” In addition, Natalie, a general education student, recounted an interaction she had with her school counsellor who, she described, was the only one who noticed that she was experiencing mental health difficulties at the time. Commenting on the impact of this interaction, the student stated: I sometimes wonder if it was incidental, if someone else had noticed first would that moment have meant so much, but I don't think so. I think coming from her, from someone who I had been with for basically my entire high school career, and she helped me through transitioning into high school and deciding which classes I want to take, which university I wanted to go to, when I heard it from her, and she didn't even know me that well, personally, but it was almost as if that made it more impactful because she noticed enough for me to take it seriously. 112 Feeling seen, heard, and valued through a student’s connection with an adult at school could have a significant impact on a student’s mental health and, as demonstrated in the last quote, the path through which they may receive support for mental health difficulties. Emphasizing the significance of interpersonal connections within the school, Julia, the principal, stated that “connections provide comfort and groundedness” and described how “connections are the fabric of the [school] building,” suggesting that connections between people are embedded and interwoven into the school’s culture. Relationships also formed the foundation for students being connected to the school, which supported student mental health. Several participants noted the benefits of the small size of the school including how it contributed to a supportive climate and, most notably, how it naturally allowed for close relationships to develop where everyone knew one another, creating a sense of community within the school, which supported student mental health. The school community was described as “caring” and “tight-knit.” The school also built connectedness through extracurricular activities and programs such as sports teams, clubs (e.g., music clubs, poetry mindfulness club, Gay Straight Alliance, Girls’ Club), events (e.g., school community market), and the music program. Hannah, the special education teacher, described how the extracurriculars that are offered support student mental health through the development of relationships and promotion of inclusivity: We do have clubs that we run that we try to encourage students to join and I think that helps with mental health in the sense of more inclusion and connecting with their peers and connecting with adults in the building. You know, we do have our GSA [Gay Straight Alliance], which is helpful for students you know who, who might be queer or gender nonconforming. I think that sends a message of like we're a very inclusive school 113 that way. And I, and so I think the clubs are a big thing to help connect kids as well as sports teams. Student and adult participants alike highlighted the significance of the music program. and the music teachers were most often cited as being the trusted adult with whom students felt comfortable talking. The music program was a major source of connection to the school for many students. Diane discussed the impact of her son’s connection to the school’s music program: I sometimes say music is keeping him alive, but at least music is keeping him in school. You know, without those music courses, he probably would be like dropping out of regular school and registering at [the alternate education school in the district]. Through the relationships that were developed between adults and peers, school extracurriculars could have a significant impact on student’s connection to school and created a sense of belonging for many students. Participants recognized the importance of relationships in supporting student mental health and adults within the school made a strong effort to cultivate relationships and integrated them into the school’s culture. Through the emphasis on relationships, students felt seen, heard, valued, and safe. Subtheme Two: Creating Safe Environments. The school’s supportive psychosocial climate also supported student mental health through the availability and development of safe environments within the school. The broad term of safety included both physical and emotional safety. In addition to being a close and tight-knit community, the school was perceived by many participants as being largely inclusive, welcoming, and accepting of everyone, with one parent, Vanessa, describing the school as having “a reputation of being inclusive.” Participants cited 114 specific examples of inclusivity, such as having a Gay Straight Alliance club and gender-neutral washrooms. In addition to relationships, a safe learning environment was acknowledged as being most important or a priority in supporting student mental health, with some school personnel noting that creating a safe environment was part of their role. Parents also recognized some of the aspects of the school that contributed to its safe environment, including the school being student-centered and supportive. Additionally, Kyle, a general education student, highlighted that the nonjudgemental support that he was provided by the school was essential. At the classroom level, Lisa, the vice-principal, emphasized the importance of well managed classrooms in creating safety as another foundation for supporting student mental health and well-being: Even this year we've been working on noticing…when you're doing classroom routines like it's so important to do those because then you, when a kid comes into a classroom, they're greeted, they feel valued, they're seen. Then they sit down. Then there's a routine so they feel safe. They know what to expect…and then it's a safe and calm environment for them to learn, which is tied with mental health so teachers have to set up an environment that's safe first and if it's not there, then everything's out the window. The safety and inclusivity of the school was attributed, in part, to its small size, relating once again back to the importance of developing relationships within the school community. Having a community where “everyone [knew]each other pretty well” and “[knew] everyone by name pretty much” created a safer environment. In addition to a safe school environment, student and parent participants identified several specific places within the school where they felt safe, including the music/choir room, Learning Assistance Class (LAC), the counselling area, the Pathways classroom, woodshop and engineering rooms. Natalie, a general education student, 115 mentioned a unique space in the school where she felt safe, particularly during a period in which she was mentally struggling, which she described as a “broom closet”: There’s a room in the office, it's like an old broom closet (laughing) if kids are feeling sick, then they say, “just go sit in the closet.” I'm laughing because when I was doing really bad, I would walk into the office, and they would just let me use that broom closet. It was like my own personal Pathways room. Lastly, participants also described how students and staff members have access to unoccupied and private rooms to attend virtual therapy sessions with their own personal therapists. The availability of a space for this purpose spoke to the school acknowledging the value and importance of students’ and teachers’ mental wellness, as well as promoted an emotionally safe school culture. Theme 2: Availability of Supports Theme 2 Overview. The second theme encompasses supports that were specifically available and most prominently described by participants as being beneficial for students experiencing mental health difficulties. Several participants cited how support is available within the school if one were seeking it. For example, one general education student, Chloe, commented: I feel like there's lots of help if I need it. I don't always need it, but I feel like there's always a place to go. Like, if I'm feeling really stressed, I know I can always go to Pathways, I can always go to LAC. I can always go to the counselors. I feel like there's a lot of people that are really nice and really supportive. Furthermore, upon discussing what receiving support meant to him, Kyle, a special education student, described it as feeling like he had “a safety net.” The school personnel who participated 116 in the study all reported having overall positive perceptions of the mental health support provided within the school. Additionally, student and parent participants reported positive experiences with at least some aspect of the support provided, especially with at least one of the available supports identified as subthemes within this theme including: 1) Understanding Adults and Flexible Practices, 2) IEP as a Communication Tool, and 3) Pathways is a “Game Changer.” Subtheme One: Understanding Adults and Flexible Practices. The first subtheme represents the availability of adults within the school who were understanding of mental health difficulties and were flexible in their teaching practices. Flexible practices referred to offering flexibility with assignment deadlines and accommodations, allowing students to complete work in a different setting (e.g., in another, quieter classroom), providing support for students who were late or absent due to mental health difficulties and needed to catch up, course programming, and allowing students to take breaks during class when needed. School staff communicated an understanding of students’ diverse needs when it comes to their mental health, including a calm, quiet, low stimulation environment; needing time to process information and emotions; balancing academic tasks and mental health needs, flexible and self-paced programming, and feeling safe. For Kyle, a special education student, he noted that “the flexibility and understanding is [sic] most important to me” when feeling supported at school. Within this subtheme, many participants described most teachers within the school as being understanding of mental health difficulties, as well as supportive and accommodating when students were struggling and in need of support. It was made clear by some participants that unsupportive teachers were the exception. There was also a shared sentiment by several participants that school staff, including teachers, were well-intentioned in terms of providing mental health support. Both student and parent participants also commented on how school staff 117 expressed or demonstrated through their words and actions wanting students to succeed and for students to do well. Diane, Kyle’s mother, who was a special education student, related this through an experience that had occurred recently: [The school has] been super helpful…and last week, I think, it just was one of those mornings that, you know, [the student, Kyle] got up, he got dressed, he tried but his gut felt all twisted and just couldn't manage…And they called and said, you know, can we give him a ride? What can we do to help him get there? So they're, they're clearly, you know, rooting for him and on his side and, and, and want to help in any way they can. Similarly, another parent of a general education student, Jessica, described the student’s support team, which involved a counsellor and a special education teacher, “a godsend,” which illustrated the positive impact of school support not only on the student, but on the parent as well. In addition to teachers and school staff more generally, the school counsellors were also highly regarded as understanding and supportive individuals within the school and identified by some students as the first place that students might seek mental health support. Counsellors were described by participants as empathic and attentive, and were perceived as effective. Several participants, mainly students, also commented on the availability and accessibility of the counsellors, with one parent saying they “exude open-doorness.” Students also experienced the counsellors as being available and willing to help. Kyle articulated: The counselor is sort of the first line…they're open door, you can just walk in and be like, “yo, I'm depressed, help.” And they can help get everything running, get with the proper people, find out, figure out solutions, talking with you in meetings. 118 As a large part of the counsellors’ role was course programming, they also demonstrated flexibility as they helped students and parents create course schedules for each semester. Jessica related her child’s counsellor’s flexibility and support in trying to create a course schedule before the start of the semester: The school is very supportive about that in terms of [the counsellor] and I connecting in August before the school year starts and reviewing [the student’s] schedule and making changes as needed, or yeah, very flexible in terms of trying to optimize her schedule, but it's not always easy. Subtheme Two: IEPs as a Communication Tool. While students did not require a designation and thus an IEP to receive support at school, as reported by one mental health professional who participated in the study, as mandatory documents, IEPs were essential tools for students who were identified as needing support at school as a result of their mental health difficulties. Although IEPs were not without their flaws, many participants, including students, described IEPs as helpful and as the youth engagement worker, Maria, stated, an IEP is “an extremely good tool, an essential tool for survival,” suggesting that IEPs were a critical aspect of the support that these students are provided. IEPs were discussed as being important communication tools for students, parents, and school personnel. Designations and IEPs communicated to school personnel the severity of the student’s mental health difficulties. Olivia, a general education teacher, expressed how designations and IEPs could help students communicate to teachers the extent of their mental health challenges and also provided teachers with a better understanding: In my experience, I think [IEPs have] helped [students] a lot. I think it allows teachers to see OK…this kid isn't just nervous or uncomfortable, this kid is either on medication or, 119 you know, has been identified by a professional that like they, they will not be able to function if this, this and this is happening. So I think it's been, once a teacher sees an IEP, they take things a lot more seriously. Similarly, one student with a designation and IEP, Lucy, noted that her need for support at school felt more “official” when she received her designation and stated that “it was like easier to help teachers understand” the extent and impact of her mental health difficulties on her academic performance. In addition to communicating the severity of one’s mental health difficulties, IEPs communicated to school personnel that the student needs additional support and further, how much support and what those specific supports were as outlined in their IEP. Although the IEP was typically a multi-page document, several school personnel highlighted what they found most helpful in terms of understanding the student’s needs, including their strengths, stretches, and the essential adaptations or strategies they required to succeed. In addition, Dan, a general education teacher, found the student’s interests helpful in relating to and developing a relationship with the student. Through communicating the type and level of support a student might need, IEPs then also communicated and provided teachers with an idea of their class composition for each semester, which could help teachers better prepare for the semester ahead. Hannah, the special education teacher, explained how IEPs were effective communication tools by assisting teachers in providing appropriate support, given the student’s unique presentation and needs. IEPs could illustrate how the same designation on paper could translate to very different presentations and types of support in practice. For Diane, a parent of a student with a designation and IEP, she believed that her child’s IEP communicated his unique needs, given his cognitive profile and mental health difficulties: 120 I think that those teachers have that, that heads up that OK, this kid has the potential for high achievement, but he's not going to get there without some support. He's highly capable, but he needs some help. IEPs allow some students, especially those who may struggle with internalizing disorders, to communicate their needs without having to talk directly to school personnel. In describing how she explained to students the purpose of an IEP, Evelyn, a school counsellor, touched upon the usefulness of an IEP for students who may struggle to advocate for themselves: What I say to the students is this is your way of asking your teacher for what you need exactly in the classroom to make it, so, I try to, you know, like, this is a tool for you to use. And often these are the kind of kids who won't self-advocate, right. So sometimes it does the work for them and they can, you know, they can just say I, you know, I do have an IEP kind of thing and that’s helpful. As recognized by Evelyn, IEPs could be very beneficial for students who struggle to communicate their needs to their teachers or other school personnel. In addition to students, one parent of a special education student, Christina, expressed that her child’s IEP provided an opportunity for her to communicate her child’s needs to their teacher and to provide a better understanding of her child’s brain and functioning, which allowed her to communicate suitable accommodations that would meet her child’s needs at school. As mentioned by most participants, including students, parents, and school personnel, IEPs were perceived as effective tools that essentially allowed students and parents to communicate the student’s needs to those supporting them at school. Reflexive Journal Entry. “I am genuinely surprised about the positive comments and perceived usefulness of IEPs that were reported by several participants. This definitely shifted 121 my perception regarding IEPs as I have not perceived them in this way. This way of framing IEPs makes me reconsider my negative views of them and helps me to see at least some of their usefulness. Maybe I have been too pessimistic about IEPs? I still think there is room for improvement for IEPs with this student population, but this is an interesting finding for me.” Subtheme Three: Pathways is a “Game Changer.” Pathways was a program within the secondary school that was created for students whose mental health difficulties were impacting their academic progress at school. This program was perceived and described by all participants involved or connected to the program as very beneficial for students, and as one parent, Jessica, stated, it was a “lifesaver” for her teenager. Maria, who was part of the Pathways team, described the program as a “game changer” in that it supported the students who were struggling with their mental health as a result of a number of different factors who might otherwise have dropped out of school. The principal, Julia, described the program and what it provided students: [The program] is that sort of soft space for kids to land throughout the day, whether they're in a crisis, whether they need to go on a consistent ongoing basis because they're too over-stimulated or too anxious and they just need a quiet calm space for a while. And they have breaks so they can use it as a drop-in or some kids have it scheduled with a full block…they'll need quiet, calm, relaxing space to go work because they can’t be productive in the classroom. Many of the themes and subthemes that were identified and previously discussed in this chapter towards understanding how the school supports students’ mental health were also identified as specifically applying to this program. For example, participants reported how there was a sense of community within the program, and the program’s classroom was identified as being another safe space for students. Kyle, a special education student who was recently put in the program 122 after experiencing some acute mental health difficulties, described the classroom as a safe space and how it had been helpful for him in comparison to the typical classroom: Well, it's sort of a safe space where you're not necessarily expected to be a hundred percent productive and writing down notes and taking in information, writing essays or whatever, but it's still school, it's still an environment that you can be productive and not just lying around at home, and like, yeah, I'm doing work at home, but I'm still just like at home, I should be at school. But at the same time, if you're struggling to do your work, or whatever, you can just, you can open up a creative project or something for 20 min, and then get, try back, because it's not like some strict class where you have strict time and everything. And if you don't have anything to do, you can just hang out. Several other participants, including students, parents, and a mental health professional, similarly expressed how having the option of going to the Pathways classroom rather than staying in the typical classroom allowed them to remain in the school building for the day whereas students might have otherwise left to go home as a result of being overwhelmed by the classroom or larger school environment. Christina explained how her child benefits from having a space like the Pathways classroom in which she can take a break as a result of her ADHD and remain at school: She has moments in class where she just has to leave the room. She just can't anymore and it's not the subject that's being taught, it’s not boredom it's just the ADHD. She just cannot sit still she cannot be in that space. She just needs to be able to get out for 10 minutes and have somewhere where she's allowed to be…It enables her to make it through the day on the day she wouldn't be able to, otherwise she would have to come home. 123 Parents of a special education student, Karla and James, articulated similar feelings about the benefits of the program in allowing their child to retreat to a safe space when the typical classroom felt overwhelming and being able to stay in the school: I think having the option of having [Pathways] to be able to catch up on work is very helpful and a safe space to go and you know, if she is in the middle of class and just gets overwhelmed and needs to leave, then she doesn’t need to leave school. So I think those things are helpful. It was evident that the program was a safe space for students who were unable to tolerate the typical classroom environment, and safe enough that students felt comfortable remaining at school, which for students who struggle with mental health difficulties, could be incredibly challenging. In addition to being described as supportive, understanding, and flexible, the Pathways team was also commended as being responsive and helpful for students and parents alike. Recalling a conversation she had with her teenager and their friends that morning about the program, Christina, a parent of a special education student, reported that, “[Pathways] on its own isn't what's beneficial. It's the people in that room and the fact that the school is small enough that they have enough attention for the people who are in there.” This parent also highlighted the safety of the program as a result of the school’s smaller size and how that facilitates deeper relationships and more support between students and the Pathways team. Karla, a parent, specifically praised the Pathways teacher, describing her as “an absolute rock and legend” and who has been instrumental in her child’s support at school. The student, Lucy, also stated this program as being the biggest change in feeling supported at school once she was given a designation. In addition to being a safe, calm, and quiet space for students, this program also offers different types of support, including academic support, strategies to support executive 124 functioning challenges, and mental health support. From a parent’s perspective, Karla explained the various ways in which the Pathways teacher supports her child in ways that meet her needs: She also tries to do work with her as well around kind of like behavioural stuff and hey, you know this is kind of a good app to use for making lists or try this technique or she's, she's really tried to do some of that with her as well which I think has been really good. But I think she just gives her the space to come and either just destress and defocus or, or really focus in on completing a piece of work or whatever she needs at the time. So yeah, [the Pathways teacher] really has been the best. Lastly, given the population of students who participated in Pathways, support was also provided in the form of monitoring attendance, and one of the student participants, Lucy, commented on the check-in her parents would get if she was absent for two or three days. This specialized program offered flexible support to vulnerable and struggling students and provided a space within the school for students to feel safe and understood. From participants feedback about the program and the team that facilitates it, the support it provided is making a tremendous difference and having a positive impact on the students who participate. Theme 3: Approaches to Support Theme 3 Overview. In addition to the availability of various supports for students experiencing mental health difficulties, adult participants frequently discussed the approaches taken by individuals in their specific roles or all together as a school team to support students’ mental health. Within this theme, three subthemes were identified: 1) Addressing the Whole Child, 2) Advocating on the Student’s Behalf, and 3) Collaborating as a Team. Subtheme One: Addressing the Whole Child. This subtheme, Addressing the Whole Child, characterizes the philosophy that the teachers and EAs who participated in the study 125 expressed when it came to their role in supporting students’ mental health. It represents the idea that they perceived their role to go beyond teaching the curriculum or strictly focusing on academic development. Teachers and EAs articulated that they believed that in their role, they were meant to help students develop not only academic knowledge and skills but focus on students’ social-emotional well-being and development, thereby supporting student mental health. In addition, administrators expressed that focusing on social-emotional well-being and development is one of the five “district priorities.” Olivia, a general education teacher, explicitly described teaching the whole child as her teaching philosophy and how that involved supporting student mental health: So I feel like as a teacher I really try to teach the whole student and so I really feel like mental health is a huge part of that, and so I wouldn't say that I necessarily act though, as a counselor, but I feel like addressing mental health or communicating with home or knowing the scope of [the] mental health of my students is very important to me. Similarly, Eva, another general education teacher, highlighted the importance of focusing on how students are feeling and how she considered various factors that could be impacting how a student presented in school on any given day: I definitely think like there has to be more focus on how the child is feeling and did they have breakfast before they came to school this morning? You know, did they have a good night rest? Are they falling asleep in your class? Are they, are they in so many activities after school that they feel like stressed or pressured? Or are there, you know, what kind of expectations on them? Eva discussed how she might have considered the student’s stressors as well as what, beyond school, may be going on in their lives that are currently impacting how they were feeling and 126 behaving. Considering different causes for a student’s behaviour was also observed during SBRT meetings. School staff who participated in those meetings expressed curiosity about the underlying meaning of a student’s behaviour and discussed the possible causes contributing to the student’s presentation. Furthermore, and as Eva noted, considerations were made about whether the student’s basic physical needs had been met. Ensuring students’ physical needs were met was discussed by other school personnel in the context of supporting student mental health, which demonstrated an understanding of how unmet physical needs, such as nutrition and sleep, could impact one’s mental health. Specifically, two participants mentioned Maslow’s hierarchy of needs in this context as a topic that was previously discussed within a school-wide approach to supporting student mental health. Going beyond curricular content, Hannah, the special education teacher, also described the importance of teaching social skills and how these skills supported student mental health: And I think that, one thing I kind of emphasize with the students is like social skills are just as important as academic skills and I think that sort of parallels the sort of mental health world in some ways, like just connecting with each other and, and caring about each other. So yeah, I do think it's an important part of my job. In addition to teachers expressing their own individual teaching philosophies of addressing the whole student, other participants communicated similar perspectives through descriptions of how schools as institutions are meant to support students in their entirety. Schools were perceived as settings in which students not only learned academic material, but as settings that, as Lisa, the vice-principal stated, “help[ed] students develop skills to function in society” simply by virtue of attending school. For example, one administrator elaborated by stating that “I think schools are like for just for developing a person, you need to figure out how to conduct yourself in a group, 127 how to behave, how to talk to people face-to-face and not just on a phone, and make mistakes and have friends and break up with people like that whole thing as a person living in society.” Relatedly, Dan, a general education teacher, communicated how schools are “a place for socialization” and for “learning social norms” where students developed skills to function in society. Consistent with this subtheme, both participants perceived the school as not solely an academic institution. While academic skills were regarded as important, schools and those who work there take part in helping students develop social emotional skills that ultimately help them to function in society. Given the reciprocal relationship between social-emotional development and mental health and well-being, focusing on this aspect of development was an approach to supporting student mental health. For the school personnel who participated in this study, supporting students’ mental health was perceived to be part of their role; however, there were other teachers within the building who were perceived as viewing mental health support as beyond their capacity. For example, Olivia, a general education teacher, noted: I just think there's some teachers and adults and administrators in the building that are like mental health is at the core of everything, we need to like treat students like holistic beings and you know there's so much of that and then there's people who are like that is so out of my scope. I would never ever speak to you about that ever and that's not my job that's not my concern. It is important to acknowledge that despite increasing emphasis and focus on mental health in schools, not every teacher will necessarily feel that it is appropriate for them to support students in that way or feel that it is their responsibility. While participants communicated that supporting student mental health was part of their role to varying degrees, many participants also 128 highlighted the boundaries within which they felt it is appropriate to support mental health within their role, including that of the school. Subtheme Two: Advocating on the Student’s Behalf. Advocating for students was another approach taken by school personnel towards supporting students’ mental health. Many participants highlighted how these school professionals were strong advocates for students who were struggling with their mental health. Advocacy often involved consulting with or speaking with a student’s teachers to request or ensure accommodations were provided, particularly for students who had difficulty advocating for themselves as a result of their mental health challenges (e.g., anxiety, depression). While students advocating for themselves occurred, it was often raised by school professionals as rarely occurring or as a goal on which the student was working. In addition to school professionals advocating for students, parents were also described as being strong advocates for their children. In describing their role and responsibilities, several school professionals, including the special education teacher and counsellors, described advocating on the student’s behalf. For example, Hannah, the special education teacher, noted that she was “also sort of an advocate for the students, so [she] might go and speak to the teachers on their behalf and talk about the adaptations and how to implement them.” The school psychologist, Nicole, also noted how “the counsellor [could] help with advocating or like talking with teachers about the kind of accommodations that could be useful for [the student].” Relatedly, Evelyn, one of the school counsellors, described what advocacy could look like and how advocating on behalf of students could fill the gap of students self-advocating: Most of the gap is filled with the relationship at our school between me and the teacher, and the Pathways teacher where we have conversations about, you know, specific things, 129 this kid has a test coming up, can they write it? Can they write the test in the Pathways classroom? Can we do this part of the test? Like it's us making the adaptations -- not the teacher -- for the most part and it’s us advocating for the student. In addition to school professionals’ descriptions of their own advocacy, several parents expressed how the school counsellors and certain teachers were advocates for their children. As previously described when discussing Pathways, the program’s teacher was a major advocate for students, particularly when it came to communicating to classroom teachers about a student’s needs related to their mental health. One parent, Jessica, described her child’s school counsellor as “a great champion” of her child and went on to describe how the counsellor and the student’s learning support teacher advocated on the student’s behalf while maintaining the student’s privacy: [The counsellor] will be an intermediary so that the teachers don't all need to know what's going on with [teen], [the counsellor and inclusive education teacher] can know, and then they can go and talk to the teachers on her behalf while protecting the privacy of her information, which I think is huge. Parents were also effective advocates for their children who struggle with mental health challenges. Some of the reported ways in which parents advocated are by reaching out to school professionals, such as the counsellors, when they were concerned about their child’s mental health, as well as by communicating with their child’s teachers to access accommodations or adaptations (e.g., emailing a teacher to get an extension for an assignment) on their child’s behalf. Parents also advocated by attending school meetings with school professionals, including IEP meetings. 130 Subtheme Three: Collaborating as a Team. The third and final subtheme involves the ways in which school personnel collaborate with one another, as well as with parents, in order to support students and their mental health and wellbeing. Collaborating as a team with one another and with parents was a crucial way in which the school community supported students experiencing mental health difficulties. The school formally collaborated as a team through the SBRT and ESBRT meetings, which also included the school psychologist. As observed during the meetings that I attended, the school team engaged in a lot of collaborative problem solving and decision-making. School staff expressed genuine concern and compassion for students’ well-being and typically generated an in-depth analysis about a student’s needs. It was also evident that the school team considered and analyzed students’ behaviour, as well as their needs, from a developmental lens and developed conceptualizations of a student to better understand them. In addition to my observations of SBRT and ESBRT meetings, all school professionals that participated described ways in which they collaborated with each other and with parents to support students, including their mental health. Maria, the youth engagement worker, stressed the importance of and the benefit of the Pathways program weekly meetings for her ability to support students when she said, “staying close with my team, staying connected with my team, that's why we have a weekly meeting, which is really important for us because that gives us like an action plan.” Both counsellors also mentioned how they worked quite closely with the administrators to support students and Evelyn elaborated on how helpful it is for the school administrators to truly understand their role as counsellors: I think that these administrators are so aware like we work so closely with administrators and they really understand what the job is and that makes a huge difference. I mean that's, 131 I don't know how many administrators I've worked with at [the school], probably 10 and it really changes the nature of the job...what helps is when our administrators really understand what we do and these guys, [the vice principal and the principal] have a really deep understanding of how it works that is super helpful. Effectively working together involves understanding each other’s role and what was involved, and it seemed particularly helpful for counsellors, whose role was specifically intended to support students’ mental health, when the leaders of the school had that understanding. Olivia, a general education teacher, also described how she worked with the counsellors in supporting students with R or H designations, “when I see an H or when I see like a mental health plan in my case of dealing with those IEPs over the years like I almost immediately go to the counselor, just like, so what do I need to know?” As counsellors were the case managers for students with R or H designations, they could be particularly helpful for teachers to consult with when trying to implement supports and adaptations for the student in their classroom. Dan, another general education teacher, also went on to describe the mutual communication that took place amongst staff when trying to support a particular student who was observed to be struggling: I have discussions with some of the EAs from Pathways, I get emails from the counsellors checking in on certain students or learning of certain changes in their lives, and so on, so yeah, I think the communication’s there so that we're better able to understand where a certain student is at any particular point. School personnel communicated with one another and provided each other with important and relevant information about how a student may be functioning in order to better understand and support the student. Victoria, an EA, also related how the school came together to support struggling students: 132 If multiple staff have been noticing a student’s really struggling, we will all discuss it, bring it to the right people, and then it will be like team-based interventions and like meetings. I think that's important. Obviously, communication with parents is super important and with administration. And if it's really not working for a student here like they could be transferred somewhere with even, I don't know, better supports, better for complex needs at school, those kind of things. Victoria highlighted how the school would try to find the most appropriate support or service for the student, regardless of whether that was within the school building or not, which was a key observation during SBRT and ESBRT meetings. During these meetings, the team developed detailed action plans to support students, and it was evident that they exhausted all options of support for students. Furthermore, the school team demonstrated a willingness to try new approaches and to adjust supports when necessary to meet the needs of the student at a given time. Home-school collaboration was a recurring theme within the data when discussing the approaches taken to support students, which was consistent with observations of the SBRT and ESBRT meetings. Communicating with parents via phone call, email, or scheduling a meeting, was a typical focus within these meetings and frequently part of the action plans created to support students moving forward. Evelyn, a school counsellor, emphasized how “lots and lots of contact with parents” was another way that she supported students. Parent participants also noted experiences they had had working with school staff to support their children. For example, Jessica, a parent of a general education student, described working “closely with the school” as a result of her daughter’s various needs, which included working with the school “quite extensively about [student’s] anxiety.” This same parent talked 133 specifically about with whom she worked and what that collaboration looked like when she reported that she “tried to work with the teachers but I ended up working with counselling services and, and [special education teacher] in LAC, who's [student]’s case manager, and at the time, I also worked with...the principal. And then when [student] started experiencing extreme emotional distress, I would have weekly or, yeah, often weekly meetings with [the counsellor] and [special education teacher] for support. Other parents discussed their communication with the Pathways team, including the teacher and the counsellor, and expressed how the teacher had “always been super responsive.” Karla, the parent of a special education student, described how “there’s been times where [the student’s mother] had to pick up the phone to [the counsellor] and say, could you go find my child, she’s crying in the corner somewhere” and how circumstances like these in which they could communicate and request support from the Pathways team “feels a bit like a team.” Theme 4: Acknowledging Boundaries Theme 4 Overview. The fourth theme, Acknowledging Boundaries, encapsulates the perceived limitations of the school and of school personnel in their efforts to support students’ mental health. Although participants’ descriptions of the school’s role in supporting student mental health varied across the data set, a recurring theme regarding the school’s perceived responsibility and limitations was identified. In addition, many participants, including administrators, teachers, and counsellors, clearly acknowledged the boundaries of supporting students’ mental health within their specific role and typically expressed confidence in the knowledge of those boundaries. Of any group of participants, parents understandably expressed the most uncertainty surrounding their own boundaries as a parent. Within this theme, three 134 subthemes were identified: 1) The School’s Role and 2) “I’m Not a Counsellor,” and 3) Parents Finding Balance in Their Role. Subtheme One: The School’s Role. In addition to developing relationships with students and creating safe spaces, many participants characterized the school’s role in supporting student mental health as comparable to mental health first aid or a triage system for students experiencing mental health challenges. There was a general consensus from school personnel that the school is meant to identify students who need additional support beyond what the school could provide and then subsequently refer them to and/or help them to access an outside agency for further support. Lisa, the vice-principal, explained her perception of the point at which the school intervenes and why that is: It's kind of the point where, like, when their mental health starts affecting their ability to learn and then that's kind of where we notice it. And then once it gets to that place, then we want to connect with the families and then refer to an outside agency because we are not (emphasized by participant) trained as mental health practitioners or psychiatric nurses…that is not the role of the school. So we have to be kind of careful that we don't overstep and like assume that we know how to best to deal with it. Given the lack of mental health professionals within the school that were specifically trained to work with youth with severe mental health difficulties, Lisa was suggesting that students are better supported through outside agencies, as schools were not equipped with sufficient and appropriate resources. Sharing a similar perspective, Diane, a parent of a special education student, acknowledged that it was not the school’s responsibility to meet all of their child’s mental health needs. Relatedly, Julia, the principal, believed the school needs “professionals outside of [the school] building to be” providing “long-term clinical counselling” as she did not 135 perceive that to be the school’s role. Part of mental health first aid and triaging is first identifying those who need the support, and Eva, a general education teacher, specifically noted how “schools should be training educators like how to identify symptoms [of mental illness] and things like that.” Other teacher participants also expressed an interest and a need for further training to improve their own or staff members’ mental health literacy, as well as to learn strategies to support students’ mental health. Offering more training to teachers who perceived there to be a need aligned with one of the school psychologist’s perceptions that part of the school’s role is to provide teachers what they need to support students. While schools play a critical role in identifying students who need mental health support, there was a general consensus among school personnel that the responsibility for providing specialized care for students with severe mental health difficulties lies beyond the school’s capacity. In addition, there was an emphasis on the need for increased training for educators to effectively recognize and address students’ mental health challenges. Subtheme Two: “I’m Not a Counsellor.” Much like the school’s limitations in its provision of mental health services and supports, many school personnel shared having boundaries within their role as teacher, EA, administrator, and counsellor in their effort to support students and their mental health. When describing their perceived role in supporting student mental health, teachers and EAs often articulated their boundaries by either stating they were “not a counsellor” or explaining how they would refer students to the counsellors (or another appropriate resource). For example, Dan, a general education teacher, noted that, “I’m not a counsellor, that's my take on it, better able to identify and find the correct people in this building who can take something further if it needs to be taken further, you know… I’m an ear, I will listen to people, but I’m not a counsellor, and I don't I, I'm very cautious of my boundaries.” 136 Similarly, Olivia, another general education teacher, explained how she has become better at acknowledging these boundaries: I honestly, I think as I, as I've kind of gotten more into the system, like even in [school district], I find I rely on the counselors a lot more now. Like I feel, I definitely feel very comfortable, you know, going to the counselor's office and just saying, hey, you know, have you checked in with this kid or so, yeah, I feel like that's come with time and kind of understanding where that boundary is. In addition, Maria, the youth engagement worker, shared that she was explicit with students with whom she was supporting that she was not a counsellor. While the teachers and EAs who participated in this study believed that supporting student mental health was part of their role, the support they provide is not in place of a trained mental health professional within the school. Referring students to or consulting with the counsellor suggested that teachers understood the limits of their ability or comfort level in providing mental health support to students. It was not only teachers or EAs who acknowledged their boundaries when supporting student mental health as Thomas, one of the counsellors, also recognized his own limitations, as well as responsibilities, and how he is explicit about these with students and parents: I'm gonna [sic] be honest with you that I, you know, I'm not a doctor. I'm not a psychologist. I'm not a psychiatrist, so, you know, I'll be there and I'll support kids. I'll make sure that I'm a liaison with them and the teacher. I'll help them with getting along with their peers. I'll help them with getting along with their parents. But when it gets into some serious mental health issues, you know, I know my limits and I know when to kind of back away. I know when to help. I know when to support. And I tell kids and then I tell parents that. 137 Subtheme Three: Parents Finding Balance in Their Role. Interestingly, each parent participant also shared, although not described or stated as explicitly, their boundaries as a parent in supporting their child. For parents, acknowledging their boundaries was typically expressed as transitioning their role from advocate to being more of a coach in order to help their child to develop skills to advocate for themselves and become more independent, especially in adolescence. Jessica commented that “[Reduced workload is] something that we need to advocate for and so often it's me sending the e-mail if it's really a big thing, then I usually send the e-mail, but I need to start transitioning that to her.” Similarly, Vanessa discussed her hesitation with intervening at school on her child’s behalf given her age and wanting her child to develop skills to self-advocate: It's okay to do it like that, you know, to help her advocate, but I'm also a bit at this point, I'm also kind of reluctant. I don't want to step in myself like she's 14, she needs to build these skills, like if it was a real safety or she was really losing like was really not healthy for her then I would step in, but it's kind of been on the edge. Unlike for school personnel, parents’ discussion of implementing boundaries when it came to supporting their child at school, which was typically in the form of advocating on behalf of their child, reflected more hesitation and uncertainty about how and when to set those boundaries. In addition, Karla, the parent of a special education student, captured the challenge of setting boundaries and wanting their child to be independent with an adolescent who has significant mental health difficulties that impacts her schoolwork: I know that you know, at this age, kids are supposed to be independent, and they're supposed to be doing it themselves. And, my God, we would love it if that was the case, like honestly, I'd much rather not spend my time doing it. I'd love it if she was, had more 138 independence about that, but so far, we have not found a way to give her that independence and also mean that she completes what she needs to complete. For many parents, especially those with adolescents who struggle with mental health challenges, it can be a difficult balance of supporting their child by intervening in matters at school or advocating on their behalf with wanting them to develop skills and independence. Theme 5: Challenges to Providing Mental Health Support Theme 5 Overview. The fifth and final theme, Challenges to Providing Mental Health Support, involves barriers that school personnel were encountering when providing support to students, as well as meeting parents’ needs. The five subthemes that were identified include 1) Systemic Barriers, 2) Limitations of IEPs and Accommodations, 3) Impact of Increasing Mental Health Needs in the Classroom, 4) Mental Health Education Lacks Meaning, and 5) Meeting the Needs of Parents. Subtheme One: Systemic Barriers. In recent years, supporting adolescent mental health has become an important focus within BC. As schools appear to be ideal environments in which to promote and support adolescents’ mental health, there has been increasingly more attention on schools to support students. During interviews, several participants reported that the school “is doing the best they can with what they have,” which perfectly encapsulated the overall sentiment from the majority of adult participants of how the school is supporting students’ mental health. It recognized the reality that there were several systemic barriers, including a lack of resources such as trained mental health professionals and capacity, that impeded their ability to meet the mental health needs of all students. One of the administrators, Lisa, specifically highlighted the need for mental healthcare practitioners, such as nurse practitioners or psychiatric nurses, to work in or with the school 139 “because the ministry is downloading a lot of that stuff on us,” referring to mental health support. This administrator was suggesting that the expectations of the Ministry of Education and Child Care did not align with the resources and capacity of the school to support students’ mental health in the way that schools were realistically having to do. The limited resources of the school also refer to the number of counsellors. While the school had two counsellors, there were over 500 students within the school, and many participants commented on the counsellors’ workload and number of responsibilities within their role. According to participants, counsellors’ workload and varied responsibilities are a barrier to developing relationships with students and providing individual counselling support to students. As a result of the number of responsibilities that the school counsellors have, they are unable to spend sufficient time with students as one of the counsellors commented that “that's the part of my job I love the most that I get to do the least actually. So it's just, it's just hanging with the kids.” As a result of a lack of resources, capacity, and funding, another barrier that was frequently mentioned was a lack of time to support students. As a result of having an insufficient number of school counsellors or other mental health professionals to support the number of students within the school, there was a lack of time in the day to possibly be able to support every student in a meaningful way. Both counsellors also specifically highlighted the amount of paperwork that was tedious, time-consuming and that impacted the time available to provide direct support to students. While schools are not expected to support students with higher mental health needs, the systemic barriers also impact the community’s capacity to support these particular adolescents. Maria, the youth engagement worker, commented on how the community resources were “under resourced and poorly managed.” She related that there were long waitlists for adolescents with 140 severe mental health difficulties, an insufficient number of psychiatrists available to adolescents, and some of the community mental health clinics that are available do not meet the (long-term) needs of students. She described the mental health system as “broken” and demonstrated sympathy for the students who were unable to receive long-term support at school but who then have to “take buses everywhere and have to go talk to a bunch of strangers” as a result of the systemic barriers. A consequence of the lack of dependable, convenient, and appropriate mental health resources for adolescents within the community was that the responsibility of supporting these students falls back on the school, which also lacks the resources, funding, and capacity. In order to support students’ mental health in the way that was needed, this mental health professional conveyed the need for more funding and a different service delivery model. Reflexive Journal Entry. “I was struck by the persistent mention of systemic barriers and how, despite the school’s best efforts to support student mental health, which I’ve learned is a significant effort as the school does so many different things, these are real challenges that get in the way of supporting student mental health at this school. Working at [government agency], I get it, but hearing participants describe these barriers and accepting them in a sense as the way it is, is disheartening. I found myself feeling a bit frustrated.” Subtheme Two: Limitations of IEPs and Accommodations. IEPs are powerful communication tools for students, parents, and school personnel. IEPs are one of the central supports provided to students with identified mental health difficulties, and they can be essential for these students, as they outline students’ strengths, goals, and, most importantly, accommodations or adaptations the student should be given in order to succeed at school. IEPs, however, are not without their limitations. Interestingly, students were the only group who did not share any criticisms about IEPs during their interviews; however, Lucy had not seen their 141 IEP until a few days prior to the interview and Kyle reported that his IEP had not yet been updated to meet his current mental health needs. In addition, Kyle felt that regardless of what was outlined on his IEP, school personnel were flexible in meeting his needs on an as-needed basis. On the other hand, the limitations that were shared by parents and school personnel, collectively, suggested that IEPs were not being used to their full potential. First of all, IEPs were lengthy documents with so many pages that teachers did not always have the time to read through the entire document. Second, it was perceived by the principal that IEPs “just seem like a lot of paper and a lot of meaninglessness.” As one of the school counsellors, Evelyn, explained, “[IEPs are] just not meaningful I don’t think…I don't think students find them meaningful enough that they will use them as a tool to advocate for themselves, if that’s what it’s supposed to be.” Parents and school personnel typically advocated on behalf of students, which was a tremendously beneficial aspect of the support that was provided to students; however, and as Evelyn pointed out, students should be using their IEP as a tool to self-advocate, which did not appear to occur very frequently. While Jessica, a parent of a general education student, reported that her adolescent typically had a self-advocacy goal on her IEP, it was still difficult to attain the goal, given the inherent difficulties of her child’s mental health challenges. For this student, and as may be the case for other students as well, their IEP may be meaningless if accommodations were not implemented proactively. Part of the IEP that lacked meaning or that was described by other participants as being irrelevant, as well as redundant for identified students with mental health difficulties was the goal-setting portion of the IEP. While this part of the IEP makes sense for other students with special needs, including those with learning challenges, some school professionals described how the importance and utility of goal setting did not transfer to students with identified mental 142 health difficulties. Furthermore, the IEP was also described by an administrator as lacking meaning because it was perceived to be used by students and parents simply as a piece of paper they were entitled to as opposed to a meaningful document that helps the student understand themselves as a learner. Julia, the principal, explained that an IEP would be more meaningful if goals were reviewed and updated on a regular basis and if students were actively working on tools and strategies to help them cope with the mental health difficulties that interfered with their academic progress. While this would be an ideal solution, the school did not have the capacity or resources to meet with individual students as frequently as would be necessary to make the IEP meaningful in this way. Relatedly, Christina, a parent, also noted that from her adolescent’s perspective, the IEPs were not being used to their full potential because they were underutilized, meaning that “they're sort of done once a year and put on a shelf and nobody really does anything with them when you know, there's a lot of good stuff in there.” Consistent with the administrator’s perspective, IEPs were not being reviewed frequently enough to be meaningful for students. The long-term impact of providing accommodations that are outlined on an IEP to students with mental health challenges was another limitation that was discussed by a few participants. For example, when discussing the advantages and disadvantages of an IEP, Maria, the youth engagement worker, discussed how she was always “questioning that very fine line between enabling and empowering” students. She further described worrying about “over rescuing” in reference to students’ ability to build resilience. In addition to over rescuing, concerns regarding students becoming overly reliant or dependent on accommodations were also expressed by participants. Some participants questioned how accommodations that are put in 143 place in secondary school impacted students once they left and had to function independently in the world. One administrator communicated this concern when she acknowledged, I think we could do a better job at fading supports because I think that people, kids, get a little bit over dependent or maybe we don’t push them as much as they could to build and they get really comfortable, especially Pathways kids, right? Who wouldn't want to be in that great, fantastic environment all the time? But then I always question, are we setting them up like for failure because how do we, we need them to be able to function in this world and they're not always gonna [sic] have the Pathways room wherever they go right? It'd be great if they did, but I know it's not, so what other tools can we help them with to help them stay in the environment that you need to be in without having to run away and go anyway? As many participants acknowledged, the school was meeting students’ current needs at the secondary school level; however, as participants highlighted, it was important to consider how the support provided at the secondary school level may impact students’ ability to function independently beyond secondary school. These concerns about the long-term impact of accommodations were also mentioned by Natalie, a general education student, who observed how the school may not be setting students up for success post-secondary: In high school, it's like a pillow almost. You are able to do basically anything, you're able to mess up in any way, and you will be forgiven. However, everyone's gearing up, especially in Grade, 12 for university and they're a lot less lenient with the individual student, they more expect you to just complete something a certain way. So, as a Grade 12, you are expected to act in a way that a college professor would see and that is, that's not connective to how high school is addressing mental health, I don't think. 144 There appears to be a delicate balance that school personnel were trying to find regarding their approach to supporting students with mental health challenges. Although accommodations and specialized programs such as Pathways were certainly beneficial and necessary for some students to succeed in the school environment, an important consideration involves balancing accommodations with the development of capacity, skills, and resilience that will support students long-term. Subtheme Three: Impact of Increasing Mental Health Needs in the Classroom. The third subtheme, Impact of Increasing Mental Health Needs in the Classroom, relates to the impact of students’ increasing needs, including mental health needs, on teachers’ ability to support students, as well as their teaching practices. As a result of the increasing number of students who were being identified with special needs, which included students struggling with their mental health, teachers now catered to many diverse needs within the classroom. For each student with a designation, there was an IEP with specific accommodations or adaptations that this student was entitled to receive. Teachers must provide this support; however, it can be challenging for teachers whose classrooms consist of a large number of identified students, which was articulated by Dan, one of the general education teachers who cited the number of students with special needs as a factor that hindered his ability to support students: I've got some classes with seven [identified/designated] students, and [implementing adaptions/strategies from IEPs] doesn’t happen because you just try to put out fires, if you've got two [identified students] yeah, it's not an, it's not an issue, but if a quarter of your class is identified, and there's no support, doesn't matter what's written on a sheet of paper like it's, it's, it's all you can do to try and maintain a civil classroom for the other students who aren't identified. 145 The reality was that as more students were requiring support in the classroom, teachers were finding it increasingly difficult to not only provide support, but to manage the classroom. The impact of students’ increasing needs on teachers’ ability to adequately support students and on the dynamics of the classroom may have been having a detrimental effect on all students, not just those who are identified as requiring support. In addition to limiting teachers’ ability to support students, general education teachers also discussed how they had observed a difference in their ability to teach curriculum material at a certain level that they had previously been able to. For example, Dan commented: I have found that I cannot teach certain things to the level I used to be able to do that because I'm dealing either with behavioural, yeah, in fact, right now, like this year, Grade 8s, things that I've taught for 18 years, 17 years, I can't get across to the students because I've got either too many identified students or the severity of those students. Olivia, a general education teacher, also described similar challenges as a result of students’ needs, including mental health needs, increasing, especially following COVID-19: It's forced a lot of teachers to just slow down. It seems to be a slowing and a sense of like academic rigor that it’s really taking a hit. There’s certain things, and I think for teachers we've had several different timetables of like how much we can fit into a quarter or a semester or a year and so I think through 2020, we kind of like lost some momentum, like as subject teachers to kind of, you know, like build this super in-depth and engaging year and now it's almost been like from 2020, kind of a sense of survival and we'll, maybe we'll just like cut this out and now we've arrived at just this kind of, like bare bones, like slowed sense of teaching. 146 Additionally, another by product was that students were not “able to see what they’re really capable of because everything’s just gotta [sic] be slow, easy.” The negative impact of adolescents’ mental health challenges on their learning and academic achievement has been consistently shown in the literature. Interestingly, these teachers were also observing at their secondary school that students’ academic potential or capabilities may have been negatively impacted by not just their own individual mental health difficulties, but possibly by the general increase in mental health needs amongst adolescents. Subtheme Four: Mental Health Education Lacks Meaning. At the time of these interviews, students within the district were learning about mental health and illness in Physical Education (PE) through Dr. Stan Kutcher’s mental health literacy curriculum. Despite learning about mental illness in school, a need for increased mental health literacy among students was identified by several participants. While the Kutcher curriculum is a well-developed and evidence-based mental health literacy curriculum, multiple staff members reported challenges related to the curriculum itself and its delivery not being meaningful for students. Upon discussing the topic of the mental health curriculum, one administrator described the perceived problem in this way: What we're finding though, too, is if we're directly teaching about this stuff the teachers are having a really hard time because it’s within that, it feels forced with the kids sometimes and within the context of a PE class. And so, you know, it's tricky unless you have really deep meaningful relationships, too, and connections with kids that that stuff is going to be feel pretty superficial. I think because kids are necessarily going to 100% engage and buy it, right? So we're always trying to figure out ways to provide that universal education for everyone in a meaningful way, right? 147 She also remarked that “there [was] a lot of room for improvement” and questioned whether it was working and meaningful for students, noting that the school didn’t “have any of that data right now.” Much like the administrator, a mental health professional at the school acknowledged that the curriculum and how it was taught was “just really lacking.” Similarly, Olivia, a general education teacher, expressed confusion about mental health literacy being taught within the PE curriculum when she stated that, I think to put it on the PE teachers is interesting because again, it's one of those topics where I don't think a lot of PE teachers become teachers because they're super stoked about mental health. Like most of the PE teachers are athletes and they want to talk about physical health and they want to talk about, you know, physical literacy and it's like one week of the year where they're where it's like to them, to most of the PE teachers that I've talked to, it's like nails on a chalkboard. It's like I can’t believe I have to bring these kids in and there is a PowerPoint that's been given to them from the district that they've all agreed to do as a department and so it just kind of like paints this like weird conversation. In addition to expressing concerns and challenges with the current curriculum, however, the mental health professional proposed that mental health literacy may be better taught by those who may be passionate about it, such as the counsellors. Additionally, rather than having mental health literacy taught in a traditional way with textbooks, that what may be more effective is having “outside facilitators come in regularly with a specific workshop…workshop on mental health and like real, honest talk, like sitting in a circle, and, and talking openly and when they do the mental health one the counsellors are in the room.” Additionally, Olivia suggested that mental health “conversations should be happening like throughout the entire year, maybe there's like one day of the week or like you know, every class needs to start with like a 10 minute like 148 check in, okay like where are you at? Like you know, to make it more of like a natural thing. I do think the curriculum is important and I think it is mandated. I just think that the delivery of it so far seems to be pretty bizarre.” Subtheme Five: Meeting the Needs of Parents. Participants largely shared positive perceptions and experiences of the mental health support that was provided and received at the secondary school. Additionally, participants demonstrated an awareness and understanding of the challenges for school personnel involved in providing support, including the systemic barriers that were previously discussed. While the school tried to meet every student’s needs, the reality was that it was not always possible to do so, which could be as a result of a number of different factors. While every participant expressed some contentment or satisfaction with some aspect of the support that was received, not everyone’s experience had been one hundred percent positive. For example, one parent discussed the negative experience of her adolescent trying to get support during a particularly stressful time in secondary school; however, this same parent praised and expressed immense gratitude for the current support her adolescent was now receiving. While most participants described the school as providing a safe environment with many safe spaces in which students could spend time, one parent, Vanessa, also questioned the culture of safety within the school after being told about a few incidents that had previously occurred at and outside of school. For example, The main washroom, like outside the school gym, apparently like kids go in there and vape, and possibly do other things, but definitely vape all the time, and, like, I don't think any kid should be uncomfortable going to the bathroom, at a public school, because someone is vaping in there or any school…everybody should have the right to go to the bathroom and safety. 149 Her concerns around safety also referred to students evidently being unable to speak up about unsafe situations, including about this perceived lack of safety in the bathroom as well as other incidents she had heard about. Although Vanessa acknowledged that they did not have all the information about certain incidents, she expressed reasonable concerns about students’ sense of safety at school. In this context, student’s sense of safety, particularly feeling safe enough to speak up if something was wrong or felt unsafe, could often relate back to relationships within the school and feeling comfortable and connected enough with adults in the school to say something. Overall, participants communicated positive experiences with teachers who were flexible and accommodating to students. One parent, Christina, also commented on the positive experience her child had had with receiving support from teachers, with one caveat: The teachers have all been quite supportive in those moments but then it sort of just evaporates, and I know they're really busy, but I don't know what their understanding is of long-term chronic mental illness. It's not like the flu, you don't just have a bout and get over it, it's like so we did have to, it's always there, and it, it ebbs and flows. Christina highlighted an important part of mental illness that was not often discussed or, from her experience, potentially not well understood by teachers, which was that mental illness is chronic, and the impact of its symptoms can fluctuate unpredictably. In circumstances outside of mental health, teachers, understandably, are not always willing to be flexible for a student time and time again; however, to support students who struggle with mental health challenges, it is crucial that teachers have an understanding of the nature of mental illness so that students can receive continuous support without feeling stigmatized, ashamed, or possibly guilty for asking for the flexibility and accommodations from teachers. 150 Lastly and relatedly, Karla and James shared a particularly frustrating experience towards obtaining support for their child, which stemmed, in part, from a perceived lack of understanding from teachers about the student’s mental health difficulties, including ADHD. During their experience, these parents described how classroom teachers “were inflexible in their teaching practices and style, and the teaching practices and styles that they were deploying were not helpful for [teen]'s way of learning.” In addition, these parents felt a lack of practical support from teachers, which made it challenging for them to support their child. For example, So just like little things like that were just so challenging. It's like, could you just e-mail me a list? Like, seriously, tell me what she's done, what she hasn't done. What do we need to make up? And then this assignment, could you tell me in the book like, what page, what page, like it was so hard to get that kind of practical support. It was over and above the, the, the, the kind of what they were prepared to do. Practical support also extended to offering solutions to help the student attend school, which was difficult for her as a result of her mental health challenges. Every student and family had their own experience of receiving needed support at school and at times, for a number of different reasons, it can be more difficult for some than others. These parents’ experiences speak to the importance and necessity of teachers developing their own mental health literacy in order to better support their students. Although it was generally reported by many participants that teachers were generally understanding of students’ mental health difficulties and accommodated accordingly, these aforementioned experiences also highlighted how an interaction or experience with a single teacher can have a lasting impact. In fact, to illustrate this point, Christina reported that “we've only encountered one teacher who just didn't, just didn't get [the student’s mental 151 health difficulties] and gave [teen] a really hard time, which is a shame, actually, because that was the prerequisite to any science program and now she's given up on sciences.” It is important to share these experiences to demonstrate that both positive and negative experiences related to receiving support can occur for the same student or family, and that although all participants expressed satisfaction with current support they were receiving, a few parents also described periods in which they were not satisfied with the support provided to their child. In a secondary school of over 500 students, the reality was that it would be incredibly challenging to meet every one’s needs despite the school’s best efforts. Chapter Summary In this chapter the findings that resulted from analyzing 22 interviews with stakeholders within the school community using Braun and Clarke’s (2022) reflexive TA are provided. Through exploring how key stakeholders within a secondary school supported the needs of students experiencing mental health challenges, five themes and 16 subthemes were identified. Participants’ experiences and perceptions highlighted A Supportive Psychosocial Climate, Availability of and Approaches to Support, Acknowledging Boundaries, and Challenges to Providing Mental Health Support. Observations of the school’s physical environment and school-based team meetings provided relevant contextual information to support several identified themes. 152 Chapter Six: Discussion Overview The purpose of the present study was to explore and understand the ways in which a secondary school in the Lower Mainland of BC provided support for student mental health. Using Braun and Clarke’s reflexive TA (2022) to analyze 22 interviews with students, parents, teachers, educational assistants, mental health professionals, and school administrators, five themes and 16 subthemes were identified to describe the ways in which the secondary school supported students’ mental health. These themes also identified barriers and challenges to the provision of support. In this chapter several key messages from these findings within the context of existing literature are discussed. Recommendations and critique of current supports for student mental health are highlighted. In addition, the strengths and limitations of the present study as well as its contribution to existing literature are discussed. Finally, the study’s implications for school psychologists in the province and directions for future research are explored. Changes to the Ministry of Education Special Education Services Manual In July 2024, the Ministry of Education and Child Care updated the language used in the Special Education Services Manual (2016) and it was renamed Inclusive Education Services: A Manual of Policies, Procedures and Guidelines. With the goal of making the language used within the document more contemporary, the terms, “special education” and “students with special needs,” were replaced with “inclusive education” and “students with disabilities and diverse abilities,” respectively. Definitions of these terms across both documents remained the same. The change in terminology aligns with current literature suggesting the negative connotations (e.g., outdated, condescending, offensive) surrounding the term “special” needs or education (Gernsbacher et al., 2016; Okoroikpa & Adaka, 2023), including associations with 153 segregation. In addition, the shift in language aligns with a general movement and broader policy (e.g., the United Nations’ Convention on the Rights of Persons with Disabilities; Ainscow, 2020) towards inclusive practices and equitable access to education. The change in language reflects an understanding and commitment from the provincial government to more inclusive language, attitudes, and practices towards students with disabilities or diverse abilities within the school setting, which impacts how students are supported within schools. Discussion of Findings in the Context of the Literature Supportive Social Climates and Relationships with Adults One of the themes identified was the cultivation of a supportive school psychosocial climate that focused on building connections with students and creating a safe and inclusive environment for learning. School staff members perceived building relationships with students as foundational to supporting student mental health and as integral to their role as educators. Students and parents also expressed the positive impact of their or their child’s meaningful connections with certain educators within the school. Participants described how relationships within the school form the foundation for school connectedness amongst students through their involvement of extracurriculars and programs offered by the school. There is an abundance of evidence that suggests that student mental health is related to dimensions of school climate, including student-teacher relationships, school safety and inclusivity, and school connectedness (e.g., Aldridge & McChesney, 2018; Gase et al., 2016; Pate et al., 2017; Wang et al., 2013). As such, this finding illustrates that school personnel made great efforts into putting well-studied research into practice and demonstrates that school personnel were knowledgeable about the importance of school climate and the power of adult-student relationships within the school in supporting student mental health and well-being. 154 It has been well-established that the quality of student-teacher relationships has a significant impact on student mental health and well-being (e.g., Allen et al., 2018; Wang et al., 2013). Participants in the present study expressed an understanding of the importance of, as well as genuine concern and interest in, developing meaningful relationships with students as a means of supporting their mental health and well-being. This finding aligns with previous qualitative research in which educators acknowledged the role of student-teacher relationships in supporting student mental health (e.g., Balagna et al., 2013; Kidger et al., 2010; Shelemy et al., 2019). The impact even reaches beyond secondary school years, as Kim (2020) found that middle and secondary school students who reported having positive and supportive student-teacher relationships had better physical and mental health in their mid-20s. In the current study, many participants highlighted the inclusive and accepting nature of the school and how that positively contributed to student mental health and well-being, a finding that has been supported within the literature (Long et al., 2021). Participants particularly highlighted the school’s efforts to be inclusive of and advocates for students who were gender- and sexually-diverse. For example, participants noted the presence of a Gay-Straight or Gender/Sexuality Alliance and gender-neutral washrooms. Previous research has demonstrated the positive impact on student well-being when school climates are supportive towards gender and sexually diverse students, including the presence of a Gay/Straight Alliances or Gender/Sexuality Alliances (Poteat et al., 2013; Proulx et al., 2018; St. John et al., 2014). These findings are particularly significant and relevant given the current political and social climate towards diversity in Canada’s neighbouring country, which, given its proximity, may have far-reaching implications for Canadian school climates. 155 The findings of this qualitative study align with the existing literature suggesting that facets of school climate are an imperative consideration for schools when reflecting on their own school-based mental health promotion, prevention and intervention measures for all students. Furthermore, as students with mental health challenges have increased difficulty engaging and connecting with school, as well as with developing connections with educators or adults at school (Gage et al., 2021; Marsh et al., 2019), focusing on school climate to support these particular students is a critical strategy in supporting their mental health. The Importance of Educator Mental Health Literacy One of the available supports within the school that made a difference for students with mental health difficulties was adults who were understanding of students’ mental health challenges and who were flexible in their teaching practices, as well as in their approaches to supporting these students academically (e.g., flexible with deadlines, attendance, accommodations, etc.). Students felt supported by the majority of adults within the school and generally recalled positive experiences with educators who were willing to accommodate as needed when students were struggling. In alignment with these findings, previous research demonstrated that teachers who respond to students’ needs and feelings with understanding and empathy and who provided support positively influenced students’ well-being (Henry and Thorsen, 2018; Lavy & Naama-Ghanayim, 2020; Samson, 2020; Wang, 2023). Additionally, García-Moya and colleagues (2020) identified “humanizing relationships” as a theme that encapsulated adolescent participants’ descriptions of positive relationships with their teachers. Humanizing relationships referred to student-teacher relationships in which teachers were supportive, responsive to students’ needs, understanding and empathic. 156 The positive experiences that were shared in the present study, however, conflict with previous qualitative studies in which students disclosed negative experiences with receiving support at school, including feeling embarrassed and humiliated, unsupported by their teachers, disrupted school services and a lack of supports (Balagna et al., 2013; Pereira & Lavoie, 2016). In cases in the current study where negative experiences with school personnel were disclosed, parents were the participants to share these in greater detail, whereas students either did not report negative experiences or did not describe these previous experiences as being impactful. As the parents who participated in the current study were dedicated advocates for their child’s mental health support at school and often collaborated with school personnel or communicated with them on their child’s behalf, it is possible that parents were more directly impacted by the challenges they were facing when trying to access support for their child. As described by parents, negative experiences often involved a lack of understanding, flexibility, and provision of accommodations when their child was experiencing mental health challenges that were impacting their attendance or ability to complete academic work. These negative experiences highlight that while many educators at this school may be understanding of mental health difficulties, there are others who do not have a comprehensive understanding of mental illness and how it impacts adolescents’ functioning, including their academic functioning. In other words, there is a need for increased mental health literacy amongst educators in order to better support students experiencing mental health challenges. Mental health literacy education for educators allows teachers to discuss mental health within the classroom with more confidence and skills than not receiving mental health literacy, and to better support students struggling with mental health difficulties (Semchuk, 2020). Previous studies have shown that mental health literacy professional development opportunities 157 have positive effects on educators’ knowledge of and attitudes towards mental health challenges (Aakre et a., 2016; Gryglewicz et al., 2018; Kelly et al., 2010; Kutcher et al., 2015). Many participants recognized the value and need of increasing the mental health literacy of educators through their recommendations concerning how the school can better support student mental health. In addition to more professional development opportunities to better understand student mental health, as well as seeking to better understand students with neurodevelopmental conditions such as ADHD and Specific Learning Disorders, educators were also looking for more practical support in assisting students experiencing mental health difficulties, including help with implementing student accommodations and learning strategies to address mental health topics in the classroom. These recommendations suggest that there is a desire from the school educators who participated to be able to better respond to and support students experiencing mental health challenges. However, as participation in the present study was voluntary, the study likely attracted educators who perceived that supporting student mental health was part of their role and who had a genuine interest in understanding and improving how they supported student mental health. The participation of educators who had different perspectives regarding their role in supporting student mental health would have contributed valuable insights into understanding how this school supported students experiencing mental health problems. Pathways as a Successful Program Within an Inclusive Education Model A prominent finding from the current study was the overwhelmingly positive feedback regarding the Pathways program within the school, particularly from students and parents. Pathways was perceived by participants as being highly beneficial for students and as making a major difference in their ability to succeed at school. Participant feedback regarding Pathways 158 was needed as there has yet to be any empirical data collected about this program. This study provides a starting place. The Pathways program handbook (2016) stated that it was not an alternate program. A defining characteristic of the program that differentiates it from an alternate education program was that students remain connected to their neighbourhood school where they could access needed support while continuing to attend regular classes, as well as maintain connections with peers and participate in their school community (School District, 2016). The inclusion of students with mental health and behavioural challenges in general education settings has been supported within the literature (Lanterman et al., 2021; McGuire & Meadan, 2022; Reed et al., 2011). Beyond behavioural support strategies, one of the key benefits of inclusive education for these students is the opportunity to remain with their peers, which can positively influence both behaviour and academic performance (Reed et al., 2011). Moreover, the inclusion of these students tends to be more effective when general education teachers can collaborate with school professionals who possess specialized training and expertise in supporting them (McGuire & Meadan, 2022), a common practice highlighted by general education teachers in the current study. Despite the clear distinction that Pathways was not an alternate education program, Pathways, as described by participants, shares similar characteristics of successful alternate education programs, which may contribute to its benefits and effectiveness for students, creating a successful middle ground with the best of both worlds. Specifically, three clusters of traits, personal/affective, academic, and structural, have been noted within the literature to contribute to the success of alternate education programs (Conner & McKee, 2008; Costley, 2009; Johnston et al., 2004; Lehr et al., 2004). Personal/affective traits relate to programs that involve school staff 159 that are perceived as caring and supportive, and that focuses on developing meaningful relationships (Smith & Thomson, 2014). Students in successful alternate education programs reported a sense of belonging and connectedness to the program (Smith & Thomson, 2014). As described by participants in the present study, the Pathways team, as well as students and parents and the relationships amongst those involved in the program were foundational for the program’s success. In addition, participants expressed feeling as if the program had its own tight-knit community within the school. Academic traits involve programs that offer individualized, self-paced learning plans for students that involve flexible scheduling and accommodations (Smith & Thomson, 2014). Additionally, successful programs offer support in various forms, including academic, behavioural, and social-emotional. As described by one of the mental health professionals within the school, Pathways offered academic, behavioural, and therapeutic support to its students. Pathways provided personalized support to students and the Pathways team advocated for accommodations and flexibility for students within their regular classrooms as well. Lastly, alternative education programs are successful if they possess structural characteristics which involve smaller environments with lower student-teacher ratios (Connor & McKee, 2008; Costley, 2009; Johnston et al., 2004; Smith & Thomson, 2014). Pathways was its own classroom within the school, creating a smaller environment for students, and because students can drop in or be in the Pathways classroom at any time, it could offer students the opportunity to receive one-on-one and individualized support as needed. The Pathways program was situated within a secondary school that had already been identified by participants as being a tight-knit community that provided safe spaces for students and in which school staff, who were caring and understanding individuals, made an effort to develop relationships with students. Having that foundation within the larger school environment 160 likely contributed, to some extent, to the success of the Pathways program at this particular school. The question remains whether the Pathways program at other secondary schools would be described similarly by students, parents, and educators or whether this particular secondary school’s climate and unique characteristics set the stage for a successful program within an inclusive education model. Acknowledging Boundaries A major finding in the current study was school personnel’s acknowledgement of the perceived limitations of the school, as well as educators’ understanding of their own boundaries within their roles when it came to supporting students experiencing mental health difficulties. Many participants in the present study viewed the school’s role as first identifying students who are experiencing mental health challenges and subsequently referring them to external agencies in the community if their mental health problems were beyond the capacity of the school. Given the interplay between mental health and academic functioning, educators suggested that it was essentially impossible to ignore students’ mental health in the classroom, a sentiment shared by teacher participants in Kidger and colleagues’ (2010) qualitative study. While participants expressed confidence in their ability to support students within the boundaries of their role, educators also acknowledged they were not trained mental health professionals. Similar to these findings, secondary school teachers who participated in Shelemy and colleagues’ (2019a) qualitative study also acknowledged the limitations of their role in supporting their students’ mental health, being careful not to become a student’s therapist. Rather than directly supporting students with mental health challenges, they also perceived their role to involve referring students to more appropriate resources and trained professionals. 161 Interestingly, the study’s findings that reflected educators’ confidence in their role in supporting student mental health and their own scope of practice conflict with previous findings that teachers lack confidence in their ability to identify signs of mental health problems and in their ability to address and support student mental health (Andrews et al., 2014; Moor et al., 2007; Walter et al., 2006). Differences in educators’ levels of confidence about their ability, as well as their limitations, to support students experiencing mental health difficulties may stem, in part, from the supportive social climate of the school and school staff members’ ability to consult with and support one another. The tight-knit community of the school extends to the supportive relationships among staff members and possibly their sense of safety within the school. As discussed in the subtheme, Collaborating as a Team, school personnel typically worked together in order to support students, which was also evident in my observations of SBRT meetings. Working together presumably further built relationships among staff members and a deeper understanding of each other’s knowledge and expertise (Vangrieken et al., 2015). As a result, educators may have felt more confident in directing students to more appropriate resources (and people) within the school if they felt assured that these students would be well supported by more skilled professionals. While educators and school staff in the present study acknowledged that addressing student mental health was part of each of their roles, some participants noted that this attitude was not necessarily shared amongst all school staff members, which was also another theme identified in Kidger et al.’s (2010) study. Participants from both studies hypothesized that these colleagues were reluctant to address mental health because they did not know how to and lacked an understanding about mental health and its impact on academic functioning. As a solution to this, participants from Kidger et al.’s (2010) study, as well as other previous research, proposed 162 integrating mental health literacy into pre-service teacher training as well as into ongoing professional development trainings (Semchuk, 2020; Shelemy et al., 2019a; Shelemy et al., 2019b). Integrating mental health literacy into pre-service and ongoing and mandatory professional development trainings may help educators who currently do not perceive supporting student mental health as part of their role to better understand the connection between mental health and academic achievement. By better understanding this relationship, educators who focus solely on teaching the academic curriculum may shift their perspective and acknowledge the value in addressing student mental health as a means to improve students’ academic outcomes. Furthermore, offering mental health literacy as ongoing professional development opportunities would meet the needs of educators in the current study who already understand and acknowledge their role in supporting student mental health. School-Based Mental Health Delivery The Impact of Systemic Barriers. Systemic barriers that impeded the school’s ability to effectively support students struggling with their mental health were acknowledged by a number of participants in the present study. Specifically, participants described the absence of sufficient resources including time, trained mental health professionals, and well-resourced and well-managed community mental health agencies, as impacting the provision of adequate mental health support. These findings demonstrate how the contextual factors described in Chapter 4 largely within the exosystem of Bronfenbrenner’s Ecological Systems model (1979, 1994), specifically at the provincial government level, can have a significant impact on school-based mental health. Similar systemic barriers have been identified in previous studies of school-based mental health support (Carlson & Kees, 2018; Fabek et al., 2023; Patalay et al., 2016). For example, Patalay and colleagues (2016) found that insufficient mental health supports for 163 secondary school students across schools in Europe were attributed to limited staff capacity, funding, access to trained mental health professionals, and poor relationships with community mental health agencies. Findings from the present study are also consistent with extant literature identifying organizational factors as significant barriers to the access of mental healthcare amongst adolescents (Garney et al., 2021; Marmura et al., 2024; Radez et al., 2021). Much like the present study, Garney and colleagues (2021) also organized their data using Bronfenbrenner’s Ecological Systems model to demonstrate the numerous contextual factors (i.e., individual, interpersonal, organizational, community, and policy) that influence adolescents’ access to healthcare. Similar to the present study, the authors found that organizational barriers including limited institutional resources, poor organizational policies, long wait times, and poor coordination of care across providers were the most prominent barriers that prevented youth from accessing healthcare, including mental healthcare. Relatedly, Radez and colleagues (2021) identified a lack of time, interference with other activities, transportation difficulties, and the cost of mental health services as systemic and structural barriers to seeking and accessing mental health care amongst children and adolescents. Furthermore, and consistent with the current findings, the availability of professional support was another major barrier including limited availability of services and long wait times, both of which were most frequently reported by youth in that study. Taken together, these findings highlight how the systemic barriers identified by this study’s participants are common and widespread in communities across the world. As youth mental health is worsening, these barriers pose significant challenges for adolescents when attempting to access mental health services within the school or their local community. 164 In addition to a lack of and limited availability of trained mental health professionals within the school to support students, which appears to be a barrier within community mental health services as well (Mamura et al., 2024; Radez et al., 2021), a noteworthy finding was the perception that the time of school counsellors, one of the only professionals within the school who possess the specialized skills and knowledge to support the mental health of students, was not being used effectively to specifically support students experiencing mental health difficulties. Participants reported that counsellors had a number of responsibilities outside of mental health support for students that increased their workload and limited their direct contact time with students. Although not explicitly discussed by study participants, the school psychologist also spent limited time at this particular secondary school, only one full day every two weeks. These findings align with previous research that demonstrated that school counsellors and school psychologists spend a large portion of their time completing activities that are unrelated to their training and expertise (Zabek et al., 2023). Furthermore, while school psychologists’ services involve consultation and completing psychoeducational assessments aimed at supporting students’ academic development, their services, outlined by the school district’s inclusive education manual, do not involve direct mental health support, through assessment and/or intervention, despite school psychologists’ extensive training in this area. As school psychologists typically have limited time within a single school, the breadth of their services is underutilized at the expense of students’ mental health. Therefore, in addition to the absence of a sufficient number of trained mental health professionals within the school, the mental health professionals who were present were unable to apply their full training and knowledge to provide the necessary and direct support to students experiencing mental health challenges. The consequences of these systemic barriers come at the expense of students’ mental health needs. 165 Together, these findings underscore the need for systemic solutions, increased funding, and improved coordination and collaboration between schools and community mental health services to ensure that students with higher mental needs receive timely and adequate care. There was a shared sentiment expressed among some participants that although schools are not expected to provide long-term support for students with more severe mental health difficulties and higher needs, which is supported by provincial documentation such as the MHiS Strategy (2020) and Pathways to Hope (2019) report, schools are still bearing this responsibility as a result of systemic barriers that are impacting community resources. As schools are already dealing with limited resources, this puts further pressure and strain on schools to support students with more severe mental health difficulties. Consequently, educators and school staff are being forced to fill gaps in mental health support without the necessary training, resources, or time. School-Based Mental Health Delivery Models. Partnerships and collaboration between schools and community agencies are a fundamental component of school-based mental health models, including the BC Mental Health and Well-Being in Schools Framework, developed by BC Children’s Hospital and Kelty Mental Health. Aligning with a Comprehensive School Health model, this framework reflects a multi-tiered systems of support (MTSS) that emphasizes community partnerships at a tier 1, universal level, as well as referrals to specialized services outside of the school at a tier 3, intervention/referrals level. While partnerships between schools and community-based mental health agencies exist in BC communities, including that of the school of this case study, schools and community-based mental health services typically continue to operate within their own silos, which contributes to the challenges to accessing services. The success of these partnerships in providing effective and sustainable mental health support in schools relies on effective collaboration and seamless coordination of supports at all levels 166 (National Center for School Mental Health, 2021). According to a recent study that explored school-based mental health promotion initiatives across the province (Goossen et al., 2024), participants (i.e., educators, school district administrators and public health practitioners) reported fragmented implementation of school-based initiatives and programs and a lack of integrated coordination across systems that impacted sustainability within schools. Furthermore, participants identified the need to improve collaboration with community partners and outside agencies for increased integrated support for students. The ICY teams are intended to be a provincial solution to bridge the gap between school-based mental health support and community mental health agencies. These teams are connected to certain communities across the province and provide services within school district boundaries (Government of British Columbia, n.d). There are currently 20 ICY teams that are operating or in the process of being implemented across the province (e.g., Maple Ridge-Pitt Meadows, Richmond, Comox Valley; Ministry of Health, 2025). ICY teams are considered multidisciplinary and involve clinical counsellors, youth substance use clinicians, and peer support workers, as well as other individuals identified by the youth as being part of their support team (Government of British Columbia, n.d.). The ICY team works flexibly with youth within the school, as well as within community settings (Government of British Columbia, n.d.). ICY teams and their integration and service implementation in schools is, at a basic level, similar to the school-based mental health model evaluated by DiGirolamo and colleagues (2021) that uses a cross-sector integrated approach in which community-based mental health providers partnered with local school districts. An essential component of this model, however, was the complete integration of community-based mental health providers into the school setting. As part of this integration, the model described by DiGirolamo et al., (2021) followed an MTSS 167 approach in which community-based mental health providers in collaboration with school staff were involved in providing mental health support at each tier (i.e., universal prevention, early intervention, and intense intervention). The collaboration at each tier of support differs from the BC model where different services (and even government bodies) are responsible for different tiers of support, creating fragmentation, inconsistencies, and gaps in mental healthcare. For example, BC’s MHiS Strategy (2020) focuses on prevention strategies that are implemented by school staff. As ICY teams are partnered with CYMH teams, which typically provide services at the intensive intervention tier, ICY teams generally provide services at the early intervention tier. The model outlined by DiGirolamo and colleagues appears to be a much more integrated version of BC’s ICY teams which minimizes barriers for students and families to accessing support. In addition, the authors found that this cross-sector integrated approach contributed to a more positive and supportive school climate. Given that both models involve partnerships between school districts and community-based mental health providers, this particular cross-sector integrated model may represent what ICY teams could potentially become within BC. Another school-based mental health model that is expanding throughout the United States involves school-based health centres (SBHCs; Arenson et al., 2019). SBHCs are clinics within schools that consist of multidisciplinary teams that provide primary and preventative healthcare services, including mental healthcare, directly to students. SBHCs are established in urban, suburban and rural locations typically with underserved populations of children and youth (Arenson et al., 2019). Much like the MHiS Strategy in BC, this model also focuses on prevention; however, prevention strategies, including the promotion of (mental) health is a shared responsibility across the multidisciplinary team. Early intervention services are also a key focus, however, which aligns with the purpose of ICY teams. Furthermore, in contrast to BC’s 168 model of referring students with higher mental health needs to agencies outside of the school, SBHCs also service youth with complex mental health difficulties (Bains et al., 2015). Unlike the BC model, SBHCs offer a centralized hub of healthcare services at each support tier that improve healthcare access for youth, reduce school absences, support follow-up care, and help prevent major causes of death amongst youth (Kjolhede et al., 2021; Keeton et al., 2012). SBHCs have been found to have a positive impact on students’ physical and mental health outcomes, as well as educational outcomes (Keeton et al., 2012; Knopf et al., 2016). The authors particularly noted the potential benefit of this type of model for rural populations, particularly as SBHCs are also increasingly integrating telehealth services into their delivery models or exclusively providing telehealth services (Love et al., 2019) which is noteworthy considering the possible application of this model to harder to reach populations in northern BC. Whether as part of a SBHC or a stand-alone program, school-based telehealth programs have been found to be effective in improving access to healthcare, including mental healthcare, to students in rural communities (Garber et al., 2020). Compared to urban areas, rural and remote communities face many additional challenges to accessing mental healthcare including but not limited to a lack of accessible resources and the lack of availability of trained mental health professionals, which leads to longer wait times (Bronstein & Mason, 2016; Michael & Jameson, 2017). In addition, due to the geographic locations of these communities, there may be a need to travel long distances to access care (Capps et al., 2021). Adolescents in rural communities have been found to prefer school-based mental health services over community-based services (Mathias et al., 2021) and the majority of students in these areas only access mental health support in schools (Nichols et al., 2017), which positions the school as a critical location for the delivery of mental health support for this 169 population. The MTSS model has been identified as best practice for the provision of school-based mental health support in rural communities (Kearney et al., 2025; O’Malley et al., 2018) and the use of MTSS in rural schools has led to a significant increase in accessing mental health services amongst youth (Berryhill et al., 2022). Using MTSS, the National Center for Rural School Mental Health (n.d.) in the United States created the Early Identification System, which is a web-based database of intervention strategies at each tier of the MTSS model to improve the ability of rural schools to support students from grades K to 12 experiencing a wide range of mental health and/or behavioural difficulties. While the interventions are implemented by school staff or the student themselves, it provides schools with greater access to evidence-based strategies that facilitate their ability to identify, prevent, and intervene upon students’ mental health difficulties (National Center for Rural School Mental Health, n.d.). While BC’s ICY teams represent a promising step toward bridging the gap between school and community mental health services, their current structure does not address the full integration seen in other models described above. These models demonstrate how fully integrated tiered systems can reduce barriers and improve outcomes for youth. As BC continues to develop its mental health supports, adopting elements from these more comprehensive and integrated models may help create a more seamless and effective system of mental healthcare for children and adolescents across the province. The Limitations of IEPs and Accommodations Alternative to IEPs. An important insight from the present study was the finding that many participants, except for students, found that IEPs were not being used to their full potential. A major shortcoming of IEPs was the perception that IEPs were not being used as a tool to facilitate self-advocacy for students or to better understand themselves as a learner. As a result, 170 although they may have provided students access to an equitable education, IEPs also seem meaningless for students identified with mental health challenges. Having IEPs be more meaningful and simplified was also a recommendation from parents who participated in Zeitlin and Curcic’s (2014) qualitative study. Moreover, IEPs were underutilized, meaning they were not being reviewed frequently enough to be useful or effective, which was also a documented finding by Donaire and colleagues (2024) in their study examining the effectiveness of IEPs. Without reviewing IEPs on a regular basis, students’ progress, goals, and needs were not monitored often enough for them to be meaningful. Lastly, difficulties implementing students’ IEPs were attributed, in part, to the number of students with IEPs who require more individualized learning support. As there are few studies that specifically focus on the purpose and effectiveness of IEPs for secondary school students experiencing mental health challenges in Canada, these findings are a significant contribution that highlight the shortcomings of IEPs for these students and how the needs of students with mental health difficulties differ from students in other inclusive education categories. To overcome the challenges and frustrations associated with IEP development and implementation, the idea of implementing universal design of learning (UDL) practices in classrooms was discussed by some participants as an alternative to IEPs. UDL is an evidence-based framework for teaching that responds to the needs of diverse learners by removing barriers to learning through flexible and adaptable teaching methods (Capp, 2017; Rose, Meyer, & Hitchcock, 2005). UDL allows students with special needs to have greater accessibility and participation in the general education classroom (Frolli et al., 2023). UDL is a widely explored topic in the research literature and UDL practices have been shown to be effective in supporting learners with special needs (e.g., Al Hamzi & Ahman, 2018; 171 Mackey et al., 2023; Roski et al., 202). Despite its relevance for students struggling with their mental health, there is a dearth of research surrounding the application of UDL principles to address the barriers for students who experience mental health challenges (Al-Azawei et al., 2016; Bray et al., 2023; Fovet, 2020; Murawski & Scott, 2019). Students with mental health difficulties, however, can greatly benefit from the use of UDL in the classroom. Fovet (2020) examined how UDL practices could be applied to higher education learning in Canada to address barriers for students struggling with mental health challenges, and some of the common barriers to accessibility discussed were also relevant for secondary school students. For example, to reduce barriers for students who struggle with oral presentations in class, Fovet proposed that instructors could allow all students the opportunity to pre-record presentations. Fovet also suggested instructor flexibility with deadlines and discusses the provision of a “bank of days of grace” in which all students were given a certain number of days they could use around deadlines. Similarly, Pereira and Ith (2024) outlined UDL strategies to improve student learning and engagement in school-based universal mental health programs, which could also be applied to classroom learning. To improve access to the information presented, Pereira and Ith suggested presenting material in multiple formats and allowing students to choose based on their needs. The authors emphasized the use of software programs and other digital tools to enhance students’ learning, particularly when teaching mental health literacy (Curran et al., 2023; Ito-Jaeger et al., 2021). Lastly, the authors proposed integrating technology, developing novel instructional materials, and incorporating student voices into the mental health program planning and design as strategies to increase engagement and interest amongst students. Taken together, these studies demonstrate multiple and diverse ways that educators can implement UDL practices into their 172 classrooms to not only support students struggling with their mental health but to facilitate the implementation of a mental health program or curriculum. While UDL is, in theory, a solution to address the needs of diverse learners, including those whose mental health challenges interfere with their learning, the implementation of UDL may be met with pushback, given the challenges involved in its implementation, including a lack of knowledge and training, a perceived increase in time required to develop and prepare lesson plans, and a lack of administrative support (Anstead, 2016; Canter et al., 2017, Katz, 2013; LaRon, 2018; Pereira & Ith, 2024). Despite these significant challenges, implementation of UDL practices to support student mental health is an important consideration as an alternative or supplement to IEPs in light of the findings that suggest that IEPs for this population of students were perceived, to some extent, as underutilized and meaningless. Unintended Consequences of Accommodations. In addition to concerns about the effectiveness of the IEP for students with mental health challenges, the present findings also reflected concerns regarding unintended consequences of accommodations for students. Educators, administrators, and mental health professionals in the present study expressed concern that the implementation of accommodations may be enabling students and hindering their ability to build resilience in the long-term. Concern was also expressed for students becoming over-reliant on these accommodations, which would impede their ability to function independently post-secondary. These findings are consistent with Greif Green and colleagues’ (2017) findings that school-based supports provided to students with anxiety often facilitated avoidance strategies, which impedes students’ ability to cope with anxiety and stress in the long-term. Additionally, Lovett and Harrison (2021) cautioned the over- and indiscriminate use and limitations of accommodations for students. 173 Concerns expressed by school staff are supported by research surrounding the negative impact of accommodations related to mental health conditions such as anxiety (Etkin et al., 2023). While accommodations can be incredibly beneficial for students with mental health challenges and provide them with equal access to class material and content in the school setting, as articulated by participants in the present study, their long-term use without any plan to gradually reduce their use over time may be a disservice to students, as it worsens symptoms in the long-term as they prepare for post-secondary plans (Iniesta-Sepúlveda et al., 2020; Wu et al., 2014). To meaningfully support students by reducing their anxiety or other symptoms and improving their overall functioning in preparation for post-secondary, schools would benefit from a different approach, which may look similar to treatment plans aimed to gradually reduce family accommodation (Lebowitz, 2020). Transition planning for students is one strategy schools typically use to better prepare students for post-secondary life. Transition planning is particularly important for students with mental health challenges, given that the transition out of secondary school is associated with a host of poor outcomes. For example, students with mental health difficulties are at higher risk of dropping out of secondary school or college (Mojtabai et al., 2016), which also has implications for students’ employment opportunities (Eisenberg et al., 2007). In addition, students with mental health challenges can become involved with the criminal justice system (Newman et al., 2009; Wagner et al., 2006). Despite the vulnerability and poor outcomes of students with mental health diagnoses or challenges, this population of Canadian students rarely undergoes the same level of transition planning that is provided to other students with disabilities (Bailey, 2024; Carter et al., 2014; Carter et al., 2009; Claes et al., 2010; Trainor et al., 2016). As an example of their lack of attention in transition planning, provincial and school district documents related to 174 transition planning mainly focus on individuals with intellectual and developmental disabilities (BC Government, 2021; Inclusion BC, 2012). An individualized, person-centred and strengths-based approach is most effective when transition planning for students with mental health difficulties (Cheney, 2012; Epstein et al., 2000; Malloy et al., 2010; Yeager et al., 2021). In Landmark, Ju, and Zhang’s (2010) comprehensive review of best transition practices for youth with mental health challenges, best practices included employment preparation; daily living, self-determination, and social skills training; family involvement; and outside agency collaboration. Students may not be aware of or knowledgeable about what they need to consider in order to live independently (Flower et al., 2015), which further highlights the need to focus on developing independent living skills in this population of students. By establishing a well-developed plan with actionable, incremental steps to reach their goals, students and their support teams can work towards slowly reducing accommodations that are initially provided to students. Transition planning for these students may focus on developing skills to manage their symptoms (e.g., cognitive-behavioural strategies, coping skills, stress management skills, sleep hygiene, reducing use of alcohol and other substances, tolerating busy environments) as well as independent living skills that will benefit and maintain good mental health, including making medical appointments, refilling prescriptions and picking up medications, managing routines and schedules, or seeking mental health and other resources in their post-secondary community (Young & Calloway, 2015). Transition planning can ensure that students are better prepared with the necessary tools and resources once they graduate from secondary school than they would be otherwise. 175 The Challenge of Making Mental Health Literacy Meaningful for Students Another challenge that was identified by participants in the present study was the shortcomings of the mental health literacy curriculum, The Mental Health and High School Curriculum Guide (‘The Guide’; Kutcher & Wei, 2018). Specifically, participants expressed challenges related to its content and delivery lacking meaning for students, and thus engagement in the material. One administrator attributed the lack of student engagement to the superficial content and the absence of foundational connections when teaching or learning mental health-related content. Other participants questioned whether PE teachers were the most appropriate educators to deliver the curriculum, given their perceived lack of passion to teach this information or expertise. As school-based interventions that include mental health literacy have been identified as being effective for students’ long-term mental health and well-being (Berger et al., 2022), an ineffective curriculum can have potentially serious consequences for adolescents’ understanding of mental illness and help-seeking behaviour. While The Guide has been shown to be effective at improving students’ mental health literacy (Kutcher et al., 2015; Milin et al., 2016), research on the efficacy of The Guide has been exclusively quantitative and focused on outcomes, as opposed to the process of implementing the program. Therefore, there is a dearth of knowledge regarding educator observations and experiences teaching The Guide to secondary school students. Due to concerns regarding student engagement, participants suggested that role models or mentors, such as individuals who have lived experience with mental health challenges, as well as more facilitators, be invited to deliver aspects of the mental health literacy curriculum, a finding that was also recommended by Corrigan (2018). Concerns about student engagement with mental health literacy programs, including their content and delivery were addressed in a recent 176 systematic review that examined factors that contributed to the efficacy of secondary school-based universal mental health and well-being programs, as well as factors that impact student engagement (Scholz et al., 2023). Unsurprisingly, findings indicated that efficacious programs were more likely to include factors that maintained student engagement. The authors identified three key components of these universal programs that contributed to their effectiveness, in part, by enhancing student engagement. Programs that involved active learning for students (e.g., physically active through writing, role play, interactive games, active participation in discussions) and that used student-centred methodology were prominent features of these programs. To apply these findings, educators can find or create opportunities for students to be more actively involved in the curriculum than they are currently by co-developing learning activities or games with students. Student engagement may also be further enhanced by having students make their own personal connections with the material. To go a step further, the school could also develop its own curriculum or program that incorporates feedback from students based, in part, on what they want to learn regarding mental health literacy. Effective programs also included teacher involvement in the program’s delivery, which the authors hypothesized may be the result of previously established relationships between students and the teacher facilitating the program. As an administrator in the present study proposed that students are not engaged in the curriculum as a result of the absence of safe and supportive relationships with the teacher delivering the material, the impact of teacher involvement on student engagement may depend on which teacher is delivering the material and how comfortable and safe students are in that teacher’s presence. Further, programs were more effective and students were more engaged when teacher facilitators were trained by psychologists or using materials developed by psychologists. While participants in the present study questioned the appropriateness and 177 effectiveness of PE teachers delivering the mental health literacy curriculum, which could potentially be impacting student engagement, administrators may consider having the school psychologist train the PE teachers in delivering the curriculum as a means of increasing student engagement. As described above, Pereira and Ith (2024) also outlined UDL strategies to improve student engagement in school-based mental health programs, which could be applied to mental health literacy curriculums. Findings from both studies offer important considerations for this school’s administrators regarding how to bolster student engagement and enhance the meaningfulness of the mental health literacy curriculum. Implications for School Psychologists The findings and themes that were identified through interviews with students, parents, teachers, EAs, mental health professionals, and school administrators concerning how mental health is addressed and supported at this secondary school have important implications for school psychologists. While findings have implications for school psychologists more generally, there are also specific implications for the school’s psychologist given the nature and specificity of the case study. Increased mental health literacy for both students and educators was an expressed need amongst participants and, for some educators, a personal interest. While the mental health literacy curriculum for students is taught by PE teachers, school psychologists may have an important role in training PE teachers in delivering the curriculum or providing supplemental materials to facilitate student learning and engagement (Scholz et al., 2022). Beyond the mental health curriculum, which takes place in one course in early secondary school grades, participants in the present study noted that mental health topics and conversations could be integrated into daily life at school. This observation is also consistent with BC’s MHiS Strategy that envisions mental health and well-being to be pervasive throughout learning 178 environments. Some educators, however, expressed being uncertain about how to effectively execute this, particularly within the boundaries of their role. In a consultative role, school psychologists can collaborate with educators to develop strategies and activities that educators can use to integrate mental health conversations into all classrooms. School psychologists, on the other hand, may have a more direct role in improving educators’ mental health literacy by developing and providing a series of ongoing professional development opportunities related to mental health literacy. Previous research with educators has emphasized the need for continuous trainings related to mental health literacy, rather than one-time training opportunities (Semchuk, 2020). The school psychologist at this secondary school can tailor trainings based on the needs of educators at this school. A major barrier for adolescents to access mental health support at school and in the community is the lack of availability of trained mental health professionals in these settings. Although school psychologists undergo extensive training and have well-developed skills in numerous areas including assessment and intervention, consultation, program evaluation, and research, making them extremely qualified to address a diverse range of student challenges (CPA, 2022), their time in schools is rarely allocated to direct intervention with students targeted at supporting student mental health despite having the skills to do so (Zabek et al., 2023). Given the typically high demand for psychoeducational assessments within schools, the majority of school psychologists’ role is often reduced to this one activity; however, it may be beneficial for schools and for the mental health of students for school psychologists to allocate more time to activities geared towards the prevention and early intervention of mental health difficulties. This type of support may be provided at the whole school, classroom, and individual levels, depending on the needs of the school. For example, to reach a greater number of students but still 179 provide services at an individual level, school psychologists can facilitate group therapy at school for students who are facing similar challenges. Finally, findings from the present study revealed concerns about the long-term impact of accommodations for students with mental health difficulties, which suggests that a different approach to goal setting on these students’ IEPs may be warranted in order to better set up students for post-secondary success. To support students long-term in this way, school psychologists can play an instrumental role in IEP and transition planning, as well as goal setting for these students, given their expertise in the intersection of student mental health and learning. School psychologists are well positioned to help these students improve their academic functioning and mental health by supporting them in the development of coping strategies through the use of therapeutic tools applied in the classroom or school setting (e.g., fear ladders, behavioural activation, breathwork, cognitive restructuring). Limitations and Strengths of the Present Study Limitations There are several limitations of the current study. A primary initial goal of the present case study was to highlight student voices, particularly students who were identified within the school as having a mental illness and needing support (i.e., students with Ministry of Education designations and IEPs). While students were involved in the present study, I soon realized that recruiting these students was more difficult than I anticipated, perhaps as a result of the nature of internalizing disorders and also the limited number of students within the school who were designated within the H category. Therefore, one of the limitations was the lack of involvement of these students specifically, but also a perceived insufficient number of student participants. Related to participants absent from the present study, another limitation was the absence of the 180 Pathways teacher’s participation as she ultimately declined to participate for reasons beyond this study. Given the overwhelmingly positive feedback from students and teachers regarding the Pathways teacher’s level of support and communication, this teacher’s perceptions and experiences in this role would have been a unique perspective and contribution to the study. An additional limitation was the absence of the participation of PE teachers at the school. As they were primarily responsible for teaching the mental health literacy curriculum and given the comments regarding the perceived limitations of having PE teachers be in a position to teach this material, their perceptions and experiences would have provided a more well-rounded perspective of this perceived issue. Another limitation pertains to the lack of data collected regarding participants’ cultural backgrounds. As I understand that these demographic characteristics are integral to participants’ experiences, the absence of this data limited my ability to examine how participants’ identities may have shaped their experiences, perceptions, or interpretations of mental health and mental health support. Reflecting upon the absence of this data, being a White researcher may have unconsciously impacted the decision (or lack of critical thought) to omit this important participant data, overlooking the importance of cultural differences. Based on my lens from that of a school psychologist, I believe I prioritized participants’ roles over their cultural identity and assumed that that perspective was most relevant to examining the mental health support at this school. Additionally, not collecting data regarding participants’ cultural backgrounds or identities, as well as demographic information about the school’s population, limited the potential for transferability given the importance of this contextual information in applying current findings to other school settings. 181 Another limitation relates to the nature of who participated in the present study. As participation was voluntary, the topic of the study likely attracted participants who were interested in school-based efforts to support student mental health and who were interested in sharing their perspectives and experiences. While participants shared a wide range of both positive and negative personal experiences, perspectives, and observations, everyone came from the perspective that supporting student mental health is important and each participant perceived there to be value in their role in supporting students’ mental health. As a result, the findings may be biased towards this underlying belief amongst those who chose to participate. Similar to having fewer student voices represented in the study, only having participants with a particular view towards school-based mental health support may limit the potential for transferability as it reduces the diversity of experiences and perspectives within the data. Initially, the present study involved focus groups with general education students and teachers. Due to teacher concerns regarding comfort level and confidentiality within a focus group with other educators, data collection involving participant voices relied solely on individual interviews. Although interviews still allowed me to gather valuable and insightful information, focus groups may have allowed for a greater number of participants and may have elicited additional data from varied perspectives. The last limitation relates to the research quality of this study, and the rigour employed. While I made efforts to contact participants via email and offer each of them the opportunity to review their interview transcript and a summary of the findings, the majority of participants did not respond to me. Having all participants review their transcripts and the findings would have contributed to the study’s credibility, ensuring greater researcher quality (Tracy, 2010). 182 Strengths and Contributions Despite its limitations, the present study has several strengths. First, the advantage of using case study methodology allowed for an in-depth and focused investigation of this secondary school to produce an enriched and holistic understanding of how students’ mental health is practically addressed and supported. Due to the emphasis on context within a case study, this methodology allowed for the exploration and description of the various contextual factors beyond the school that influence school-based mental health support for a secondary school in BC, which contributed to developing a more comprehensive picture of the school-based mental health support and enhanced the potential for transferability. The use of multiple methods of data including interviews, observations of the school’s physical environment and SBRT meetings, as well as document reviews also enhanced the findings of the current case study. Additionally, although the inclusion of more student voices was an initial goal, another strength and contribution of the present study was the inclusion of multiple voices within the school community. Within the literature, studies examining school-based mental health or adolescent mental health typically involves one specific group of participants (e.g., adolescent perspectives, caregiver perspectives, or educator perspectives); however, the present study included the voices of students, parents, teachers, educational assistants, various mental health professionals, as well as administrators. The inclusion of school administrators was another particularly unique contribution, as their perspectives have been left out of the research literature. While the lack of generalization of study findings may be perceived as a limitation given that they are rooted within the specific context of one particular school, in the current case, the focused approach on a single secondary school enhanced the practical implications for the school. Generalization was not a goal of the methodological approach of this study. This 183 approach utilized in the present study lends itself to the development of concrete recommendations and suggestions for changes that are tailored to the unique needs and climate of this school, while keeping in mind the systemic barriers that this school faces. In addition to findings that discussed the school’s challenges as well as recommendations for improvements suggested by participants, a strength of the current study was that it highlighted numerous strengths of the school regarding how the school supports students’ mental health. Lastly, a strength of the present study is its contribution to the local school-based mental health literature within the province. In BC, there has been increasing attention being paid to adolescent mental health concerns, particularly post-COVID-19, and an increasing emphasis on schools to promote and support student mental health. Given the timing of the present study, this study examined the practical implications for a secondary school in their efforts to support adolescent mental health and wellbeing during a period in which students were experiencing increasingly severe mental health difficulties. As schools are guided by provincial policies and procedures to support students struggling with mental health challenges, this study also examined the school’s achievements and challenges in translating these guidelines, policies, and procedures into practice, which is a unique contribution of the current study. Another contribution of this present study is that it highlights the ongoing challenges that this school (and likely many others within BC) faces and the unique complexities of the systemic barriers that exist specifically within the province for the provision of school-based mental health support. By providing an in-depth exploration of a secondary school’s approach to mental health support, this study not only contributed valuable insights to the local research literature but also offers practical recommendations that may inform future school-based mental health initiatives in BC. 184 Considerations for Future Research The findings from the present study provided interesting and useful considerations for future research. Participants discussed the Pathways program very positively and it seemed to have a beneficial impact on students’ experiences at school as a result of the varying levels of support it provided. Future research may further investigate the specific mechanisms through which this program is successful. For instance, a case study design lends itself well to this type of investigation. Future research may focus solely on the Pathways program in this secondary school or expand to other secondary schools in the district to determine the effectiveness of other Pathways programs. Furthermore, it would be interesting to explore if the effectiveness of the program is dependent on the school in which it is located. Second, an important finding in the present study related to the concerns surrounding the long-term impact of academic and social-emotional accommodations for students experiencing mental health difficulties. Future research is required to determine whether these types of accommodations are doing more harm than good for students in the long term and whether they are setting students up for failure upon graduating from secondary school. Furthermore, if this is the case, how does this change how schools support students whose mental health challenges impact their functioning at school? Relatedly, an identified gap within the Canadian school-based literature is transition planning for students with mental illness from secondary school to post-secondary life. Given the negative outcomes associated with this transition for this vulnerable population, further research to explore what transition planning involves and whether it meets the needs of these students would be beneficial. Finally, IEPs are central components to the support provided to students with identified mental health challenges. However, there is a lack of empirical research regarding the usefulness 185 of the current IEP document in BC for this population. Given the feedback from the study’s participants, further research would be beneficial to determine whether IEPs are meeting students’ needs and how they may be improved. In addition, through the discussion of the shortcomings of IEPs amongst participants, the idea of UDL was proposed as a possible alternative for IEPs. While UDL practices are applied in classrooms to make learning accessible for students with disabilities and diverse abilities, there is a paucity of research that examines the application of UDL specifically for students with mental health challenges (Al-Azawei et al., 2016; Bray et al., 2023; Fovet, 2020; Murawski & Scott, 2019;). Future research is needed to determine how UDL practices can help schools support students with mental health difficulties. Final Reflection As I come to the end of this study, I thought it may be important to share some reflections about my experiences throughout the research process. The biggest shift for me as I worked with this school and completed my data collection and analysis, while simultaneously gaining more clinical experience outside of my research, was how my perspective significantly changed. I think I had a narrow view of what constituted support for these students and I possessed unrealistic expectations about what schools should be doing to support students and their capacity to do so. I gained insight into the different forms of support that were provided to students. I had a particularly negative view of the usefulness of IEPs for students with Category R and H designations, a view that I continue to have in some respects, and which was validated through my conversations with school personnel; however, I also learned the ways in which IEPs have the potential to be more useful for students, parents, and school personnel. While I had a general understanding of a school’s barriers and challenges to providing support to students with mental health concerns, listening to the complexities and nuances of these challenges and 186 learning more about the contextual factors that impacted the school was illuminating and allowed me to shift my perspective. In addition, working at a government agency that provides mental health support to children and youth while completing this research study provided me with a new lens through which to view the impact of these systemic barriers given the similar challenges I encounter in my work. At the same time, I was mindful while interpreting the dataset to not allow my own frustrations with these systemic barriers to cloud the story of the school, despite their significance towards the provision of mental health support. This research process not only broadened my perspective but influenced my applied practice given that I am in a position at this agency in which I work with school personnel. For example, I am at times invited to participate in IEP meetings and insights from the study findings will now influence the approach I take within these meetings, particularly when discussing accommodations and my role in helping students gradually adapt to school settings or situations. In addition, working closely with schools to help my clients transition from secondary school to post-secondary will be another important area of focus. This research has equipped me with a more nuanced, empathetic, and realistic perspective that will shape how I support students and collaborate with schools moving forward. Concluding Remarks The present study used an embedded single case study design to explore and understand the ways in which a secondary school in the Lower Mainland of BC provided support, through its practices and overall climate, for student mental health. Data collected through interviews with 22 stakeholders within the school community, observations of the school’s physical environment and SBRT meetings, and provincial and school district document reviews revealed the achievements, challenges, and barriers the school faces in providing school-based mental 187 health support to its students. Furthermore, Bronfenbrenner’s Ecological Systems model (1979, 1994) was a sensitizing lens through which the contextual factors impacting the provision of school-based support could be organized and described. Findings from this study highlighted the relational nature of school-based mental health support and will provide the school with valuable information and insights regarding the strengths of their provision of supports, such as the school’s supportive and inclusive climate and the Pathways program, as well as practical recommendations for areas that were identified as challenging for the school (e.g., delivery of mental health literacy curriculum). Furthermore, the emphasis on context within the case study methodology highlighted the many influential factors and systemic barriers that impede the school’s provision of support, which has significant consequences for effectively meeting the mental health needs of adolescents. 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Journal of Psychoeducational Assessment, 28, 139-152. https://doi.org/10.1177/0734282909344205 239 Appendix A: Letters of Information School-Based Support For Students With Identified Mental Health Concerns: A Case Study Letter of Information for Parent Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXXX@XXXXX.XXX ____________________________________________________________________________ Dear Parent/Guardian/Caregiver, We are writing to inform you of a research study taking place at your child’s high school about how it supports student mental health, particularly students with an identified mental health concern. As your child’s school as the case study, we would like to better understand to what extent your child’s high school is meeting the mental health needs of its students, as well as creating safe and positive environments that promote and support student mental health. This letter is intended to introduce you to the study and to describe what is involved. What is this study about? We would like to explore and understand the ways in which your child’s high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your child’s school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. What is involved in the study? The information will be gathered through individual and group interviews, classroom and school-based meeting observations, and document reviews. The information we learn will be used for Ms. Ruddy’s dissertation. The research study involves some students, parents, teachers, mental health professionals, and administrators taking part in a one-to-one interview with the researcher or a group interview about their perceptions and experiences about how mental health needs have been addressed and supported at your child’s school. Participants will be asked to complete a brief background questionnaire before each interview or focus group. 240 Observations of classroom activities and teaching, as well as the physical space of the school will take place in order to provide a rich description of the context of your school. School and classroom observations will not focus on individual students. If your child is observed, their identifying information will remain confidential. Another component of the research study is the analysis of documents including student participants’ Individual Education Plans (if they choose to share them), as well as provincial and school documents pertaining to special education guidelines and mental health policies. These documents will provide important contextual information about your school and how it supports its students at the school-level. Data collection would take place over the course of the school year. Due to the changing nature of the COVID-19 pandemic, the interview and/or focus groups will take place either online via Zoom or in-person. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. If you would like to learn more about the study or would like to take part in the parent interview or focus group, please contact Alexandra Ruddy by email or phone number listed at the beginning of this letter. Sincerely, Laurie Ford, Ph.D. Associate Professor Principal Investigator University of British Columbia Alexandra Ruddy, M.A. Ph.D. Candidate in School and Applied Child Psychology Co-Investigator University of British Columbia 241 School-Based Support For Students With Identified Mental Health Concerns: A Case Study Letter of Information for Students Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear Student, We are writing to inform you of a research study taking place at your high school about how it supports student mental health, particularly students with an identified mental health concern. As your school as the case study, we would like to better understand to what extent your high school is meeting the mental health needs of its students, as well as creating safe and positive environments that promote and support student mental health. This letter is intended to introduce you to the study and to describe what is involved. What is this study about? We would like to explore and understand the ways in which your high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. How is your school involved in the study? The information will be gathered through individual and group interviews, classroom and school-based meeting observations, and document reviews. The information we learn will be used for Ms. Ruddy’s dissertation. The research study involves some students, parents, teachers, mental health professionals, and administrators taking part in a one-to-one interview with the researcher or a group interview about their perceptions and experiences about how mental health needs have been addressed and supported at your child’s school. Participants will be asked to complete a brief background questionnaire before each interview or focus group. Observations of classroom activities and teaching, as well as the physical space of the school will take place in order to provide a rich description of the context of your school. School and 242 classroom observations will not focus on individual students. Identifying information about students around the school or within classrooms that are observed will remain confidential. Another component of the research study is the analysis of documents including student participants’ Individual Education Plans (if they choose to share them), as well as provincial and school documents pertaining to special education guidelines and mental health policies. These documents will provide important contextual information about your school and how it supports its students at the school-level. Data collection would take place over the course of the school year. Due to the changing nature of the COVID-19 pandemic, the interview and/or focus groups will take place either online via Zoom or in-person. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. If you would like to learn more about the study or would like to take part in the interview or focus group, please contact Alexandra Ruddy by email or phone number listed at the beginning of this letter. Sincerely, Laurie Ford, Ph.D. Associate Professor Principal Investigator University of British Columbia Alexandra Ruddy, M.A. Ph.D. Candidate in School and Applied Child Psychology Co-Investigator University of British Columbia 243 Appendix B: Letters for Initial Contact School-Based Support For Students With Identified Mental Health Concerns: A Case Study Letter for Initial Contact for Parents/Guardians Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear Parent/Guardian/Caregiver, We are writing to invite you to be part of a research study about how your child’s high school supports student mental health, particularly students with an identified mental health concern. Your participation is very important to help us better understand to what extent your child’s school is meeting the mental health needs of its students, as well as creating safe and positive environments that promote and support student mental health. This letter is intended to introduce you to the study and to describe what it would mean to take part. What is this study about? We would like to explore and understand the ways in which your high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews, classroom and school-based meeting observations, and document reviews. The information we learn will be used for Ms. Ruddy’s dissertation. What is involved if you take part in the study? The research study involves taking part in a one-on-one interview with the researcher about your perceptions and experiences regarding how your child’s identified mental health needs or how student mental health more generally have been addressed and supported at their school. Due to the changing nature of the COVID-19 pandemic, the interview will take place either 244 online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to you. If the interview takes place in-person, the location will be a quiet and private place such as a room in your school, a community centre, or a public library. A place that works well for you. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. Before the interview, you will be asked to complete a brief background questionnaire. The interview will take approximately 1-1.5 hours. There may be a need for a brief follow-up interview to expand on or clarify information from the first interview. With your permission, the interviews will be audio-recorded (and video recorded if on Zoom) and transcribed. Over Zoom, you may turn your camera off, mute your audio, and change your display name on Zoom (for example, using a nickname). Your identity will remain confidential, but parts of your interview and/or direct quotes from the interviews may be used in Ms. Ruddy’s dissertation without sharing any identifying information. If you would like, a summary of the results will be sent to you once the study is completed. Taking part in this study is voluntary. You may refuse to take part and withdraw only until the analysis of the data for the research project is done. More details will be given when you provide your informed consent prior to the interview. If you would like to learn more about the study or would like to take part, please contact Alexandra Ruddy by email or phone number listed at the beginning of this letter. Sincerely, Laurie Ford, Ph.D. Associate Professor Principal Investigator University of British Columbia Alexandra Ruddy, M.A. Ph.D. Candidate in School and Applied Child Psychology Co-Investigator University of British Columbia 245 School-Based Support For Students With Identified Mental Health Concerns: A Case Study Letter for Initial Contact for Students Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear Student, We are writing to invite you to be part of a research study about how your high school supports student mental health, particularly students with an identified mental health concern. Your participation is very important to help us better understand to what extent your high school is meeting the mental health needs of its students, as well as creating safe and positive environments that promote and support student mental health. This letter is intended to introduce you to the study and to describe what it would mean to take part. What is this study about? We would like to explore and understand the ways in which your high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews, classroom and school-based meeting observations, and document reviews. The information we learn will be used for Ms. Ruddy’s dissertation. What is involved if you take part in the study? The research study involves taking part in a one-to-one interview with the researcher about your perceptions and experiences about how student mental health and/or your identified mental health needs have been addressed and supported at your school. Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to you. 246 If the interview takes place in-person, the location will be a quiet and private place such as a room in your school, a community centre, or a public library. A place that works well for you. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. Before the interview, you will be asked to complete a brief background questionnaire. The interview will take approximately 1-1.5 hours. There may be a need for a brief follow-up interview to expand on or clarify information from the first interview. With your permission, the interviews will be audio-recorded (and video recorded if on Zoom) and transcribed. Over Zoom, you may turn your camera off, mute your audio, and change your display name on Zoom (for example, using a nickname). If applicable, another component of the study may include reviewing and discussing with you your Individual Education Plan (IEP). As your IEP reflects the mental health and/or academic support you are receiving at school, it will be informative to review the support you are receiving and how it meets your needs. In addition, with your permission, Ms. Ruddy will attend one of your IEP meetings. Your identity will remain confidential, but parts of your interview and/or direct quotes from the interviews may be used in Ms. Ruddy’s dissertation without sharing any identifying information. If you would like, a summary of the results will be sent to you once the study is completed. Taking part in this study is voluntary. You may refuse to take part and withdraw only until the analysis of the data for the research project is done. More details will be given when you provide your informed consent prior to the interview. If you would like to learn more about the study or would like to take part, please contact Alexandra Ruddy by email or phone number listed at the beginning of this letter. Sincerely, Laurie Ford, Ph.D. Associate Professor Principal Investigator University of British Columbia Alexandra Ruddy, M.A. Ph.D. Candidate in School and Applied Child Psychology Co-Investigator University of British Columbia 247 School-Based Support For Students With Identified Mental Health Concerns: A Case Study Letter for Initial Contact for School Personnel Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear School Personnel, We are writing to invite you to be part of a research study about how your high school supports student mental health, particularly students with an identified mental health concern. Your participation is very important to help us better understand to what extent your high school is meeting the mental health needs of its students, as well as creating safe and positive environments that promote and support student mental health. This letter is intended to introduce you to the study and to describe what it would mean to take part. What is this study about? We would like to explore and understand the ways in which your high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews, classroom and school-based meeting observations, and document reviews. The information we learn will be used for Ms. Ruddy’s dissertation. What is involved if you take part in the study? The research study involves taking part in a one-to-one interview with the researcher about your perceptions and experiences about how students’ identified mental health needs or student mental health more generally have been addressed and supported at your school. Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to you. 248 If the interview takes place in-person, the location will be a quiet and private place such as a room in your school, a community centre, or a public library. A place that works well for you. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. Before the interview, you will be asked to complete a brief background questionnaire. The interview will take approximately 1-1.5 hours. There may be a need for a brief follow-up interview to expand on or clarify information from the first interview. With your permission, the interviews will be audio-recorded (and video recorded if on Zoom) and transcribed. Over Zoom, you may turn your camera off, mute your audio, and change your display name on Zoom (for example, using a nickname). Your identity will remain confidential, but parts of your interview and/or direct quotes from the interviews may be used in Ms. Ruddy’s dissertation without sharing any identifying information. If you would like, a summary of the results will be sent to you once the study is completed. Taking part in this study is voluntary. You may refuse to take part and withdraw only until the analysis of the data for the research project is done. More details will be given when you provide your informed consent prior to the interview. If you would like to learn more about the study or would like to take part, please contact Alexandra Ruddy by email or phone number listed at the beginning of this letter. Sincerely, Laurie Ford, Ph.D. Associate Professor Principal Investigator University of British Columbia Alexandra Ruddy, M.A. Ph.D. Candidate in School and Applied Child Psychology Co-Investigator University of British Columbia 249 School-Based Support For Students With Identified Mental Health Concerns: A Case Study Letter for Initial Contact for School Mental Health Professional Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear School Mental Health Professional, We are writing to invite you to be part of a research study about how your high school supports student mental health, particularly students with an identified mental health concern. Your participation is very important to help us better understand to what extent your high school is meeting the mental health needs of its students, as well as creating safe and positive environments that promote and support student mental health. This letter is intended to introduce you to the study and to describe what it would mean to take part. What is this study about? We would like to explore and understand the ways in which your high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews, classroom and school-based meeting observations, and document reviews. The information we learn will be used for Ms. Ruddy’s dissertation. What is involved if you take part in the study? The research study involves taking part in a one-on-one interview with the researcher about your perceptions and experiences about how students’ identified mental health needs have been addressed and supported at your school. Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to you. 250 If the interview takes place in-person, the location will be a quiet and private place such as a room in your school, a community centre, or a public library. A place that works well for you. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. Before the interview, you will be asked to complete a brief background questionnaire. The interview will take approximately 1-1.5 hours. There may be a need for a brief follow-up interview to expand on or clarify information from the first interview. With your permission, the interviews will be audio-recorded (and video recorded if on Zoom) and transcribed. Over Zoom, you may turn your camera off, mute your audio, and change your display name on Zoom (for example, using a nickname). Your identity will remain confidential, but parts of your interview and/or direct quotes from the interviews may be used in Ms. Ruddy’s dissertation without sharing any identifying information. If you would like, a summary of the results will be sent to you once the study is completed. Taking part in this study is voluntary. You may refuse to take part and withdraw only until the analysis of the data for the research project is done. More details will be given when you provide your informed consent prior to the interview. If you would like to learn more about the study or would like to take part, please contact Alexandra Ruddy by email or phone number listed at the beginning of this letter. Sincerely, Laurie Ford, Ph.D. Associate Professor Principal Investigator University of British Columbia Alexandra Ruddy, M.A. Ph.D. Candidate in School and Applied Child Psychology Co-Investigator University of British Columbia 251 Appendix C: Letter for Parents School-Based Support For Students With Identified Mental Health Concerns: A Case Study Letter for Parents for Student Interview Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear Parent/Guardian/Caregiver, We are writing to invite your child to be part of a research study about how their high school supports student mental health, particularly students with an identified mental health concern. Your child’s participation is very important to help us better understand how their school is meeting the mental health needs of its students, as well as creating safe and positive environments that promote and support student mental health. This letter is intended to introduce you to the study and to describe what it would mean for your child to take part. What is the purpose of the study? We would like to explore and understand the ways in which your child’s high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your child’s school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews and the information we learn will be used for Ms. Ruddy’s dissertation. What is involved if your child takes part in the study? The research study involves your child taking part in a one-to-one interview with the researcher to talk about their perceptions and experiences about how their identified mental health needs have been addressed and supported at their school. Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that your child and the researcher mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to your child. 252 If the interview takes place in-person, the location will be a quiet and private place such as a room in their school, a community centre, or a public library. A place that works well for them. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. Before in-person research, we will ask participants a pre-determined series of health-related questions for COVID-19 screening. If your child develops symptoms within 5 days of contact, we ask that they notify the research team. The first interview will take about 1-1.5 hours. With your child’s permission, the in-person interview will be audio-recorded and notes will also be taken. After the interview, the researcher will transcribe the audio recording. If the interview takes place over Zoom, the conversation will be video and audio recorded for the purpose of the research project. Your child may turn their camera off, mute their audio, and change their display name on Zoom (for example, using a nickname). We might ask if your child would like to take part in a follow up interview. We will also provide your child with the opportunity to review the interview transcript for accuracy, clarification, and the need for any changes. Another component of the study will include reviewing and discussing with your child their Individual Education Plan (IEP). As their IEP reflects the mental health and/or academic support they are receiving at school, it will be informative to review the support they are receiving and how it meets their needs. In addition, with your child’s permission, Ms. Ruddy will attend one of their IEP meetings. Your child’s identity will remain confidential, but parts of your child’s interview and/or direct quotes from the interviews may be used in Ms. Ruddy’s dissertation without sharing any identifying information. If you would like, a summary of the results will be sent to your child once the study is completed. Taking part in this study is voluntary and your child may refuse to take part or withdraw at any time. The only risk associated with participating in the study is that it is possible that your child may feel uncomfortable by some of the questions that are asked. If your child feels uncomfortable, they may choose to stop at any time. If any of the questions in the interview make them feel uncomfortable, they may choose not to respond to those questions. More details will be given when your child provides informed consent prior to the interview. If you would like to learn more about the study or if your child would like to take part, please contact Alexandra Ruddy by email or phone number listed at the beginning of this letter. Sincerely, Laurie Ford, Ph.D. Associate Professor Principal Investigator Alexandra Ruddy, M.A. Ph.D. Candidate in School and Applied Child Psychology 253 University of British Columbia Co-Investigator University of British Columbia 254 Appendix D: Consent Forms School-Based Support For Students With Identified Mental Health Concerns: A Case Study Parent Consent for Interview Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear Parent/Guardian/Caregiver, Please read the following carefully. We are asking you to take part in the study we are doing with your child’s high school. If, after reading this letter, you would like to take part in this research study, please sign one copy and keep the other copy for yourself. What is this study about? We would like to explore and understand the ways in which your child’s high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your child’s school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews and the information we learn will be used for Ms. Ruddy’s dissertation. What happens if you want to participate in this study? • Participating in the study means that you will take part in a one-on-one interview about your perceptions and experiences regarding how your child’s identified mental health needs have been addressed and supported at their school. • Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to the participant. 255 • If the interview takes place in-person, the location will be a quiet and private place such as a room in your child’s school, a community centre, or a public library. A place that works well for you. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. • Before in-person research, we will ask participants a pre-determined series of health-related questions for COVID-19 screening. If you develop symptoms within 5 days of contact, we ask that you notify the research team. • If the data collection is completed online, it will be using the Zoom platform, which is a video-conferencing service. Access to the Zoom platform will require a device capable of video conferencing, a stable internet connection, and a private space to partake in the study. • The first interview will take about 1-1.5 hours. We might ask if you would like to take part in a follow up interview. If so, we will decide that at the end of the first interview and the 2nd interview will not last more than an hour. • The in-person interview will be audio-recorded and notes will also be taken. After the interview, the researcher will transcribe the audio recording. If the interview takes place over Zoom, the conversation will be video and audio recorded for the purpose of the research project. You may turn your camera off, mute your audio, and change your display name on Zoom (for example, using a nickname). The audio and video recordings will be used so the researcher has an accurate transcription of the conversation to analyze. Only the data from Zoom recordings and not the audio and video recording themselves will be used for any future uses, including publications and/or presentations. • If you agree to take part in the study, we will ask you to answer a background questionnaire before the interview. • After the interview is transcribed, the researcher will contact you to give you an opportunity to review the transcript for accuracy, clarification, and need for any changes. This may take up to 30 minutes and will be done in person, over the phone, or via Zoom, your choice. If it is done over the phone or via Zoom, the transcript will be emailed to you in advance via password protected file, so you have it in front of you to review while we talk with you. • Participation in the study is voluntary. You may stop your participation without repercussion up until the analysis of the data for the research project is done/ Study Outcomes • Taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in presentations or publications (e.g., journal articles, a report, a summary) without the inclusion of any information that would identify you. 256 • Data from this research project used in presentations or publications may be freely accessed by the public. Once the data is made available in this way, you will not be able to withdraw your data. What are the risks of participating? • The only risk associated with participating in the study is that it is possible that you may feel uncomfortable by some of the questions that are asked. If you feel uncomfortable, you may choose to stop at any time. If any of the questions in the interview make you feel uncomfortable, you may choose not to respond to those questions. You are welcome to contact us with any questions. If questions during the interview raises issues or feelings that you would like support in dealing with, the researcher will provide you with community resources that you can access and will provide you with any support in accessing those services. What are the benefits of participating? • There are no explicit benefits to you by taking part in this study. However, your participation will provide you with the opportunity to voice your opinion on your experiences and perceptions about how your child’s school supports their mental health needs. Your participation will contribute towards developing a better understanding of how your child’s school supports students’ mental health. How will my identity and information remain confidential? • The information you give us is strictly confidential. No individual information will be reported and no participant or their school will be identified by name in any reports about the study. All paper data files collected will be stored in a locked filing cabinet in the lab and electronic and digital files will be password protected and encrypted at the university office of the researchers on the UBC Vancouver campus. Audio and video recordings from Zoom will be stored on UBC’S licensed Zoom cloud server. These files will be kept for a minimum of 5 years after the completion of the study and presentation or publication of results. At the end of the 5-year period, if there is no need for the data, paper copies may be shredded, and electronic and digital files will be deleted. • The only people who will have access to the information you give us are the researchers working on this study. All of the information from our conversations will be kept safe and secure. Contact for concerns or complaints about the study: • If you have any questions you can talk with us anytime. We can talk with you in person, or you can call us/email us. Our emails and phone numbers are written at the top of this letter. • If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598. 257 Consent to Participate in this Research Project By signing below, it means you consent (want) to take part in this research study. Your participation in the study is entirely voluntary and you may stop your participation without repercussion up until the analysis of the data for the research project is done. When you sign below it also means that you have received a copy of this consent form for your own records. Once you have signed the consent form, please return your form directly to Alexandra Ruddy by: • Email at XXXXX@XXXXX.XXX • Placing it in the designated box at the main office of XXXX Secondary ________________________________ Your Name (Please Print) ____________________________________________________________ Your Signature Date Please also indicate whether you consent or do not consent to the following: Please indicate if you agree to be audio recorded: Yes ______ No If the interview takes place over Zoom, please indicate if you agree to be video recorded: _____ Yes _____ No 258 School-Based Support For Students With Identified Mental Health Concerns: A Case Study Parent Consent for Student Participation in Interview Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear Parent, Please read the following carefully. We are asking your child to take part in the study we are doing with your child’s high school. If, after reading this letter, you would like your child to take part in this research study, please sign one copy and keep the other copy for yourself. What is this study about? We would like to explore and understand the ways in which your child’s high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your child’s school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews and the information we learn will be used for Ms. Ruddy’s dissertation. What happens if you want your child to participate in this study? • Participating in the study means that your child will take part in a one-on-one interview to discuss their perceptions and experiences about how their identified mental health needs have been addressed and supported at their school. • Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to your child. • If the interview takes place in-person, the location will be a quiet and private place such as a room in their school, a community centre, or a public library. A place that works well for them. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use 259 of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. • Before in-person research, we will ask participants a pre-determined series of health-related questions for COVID-19 screening. If your child develops symptoms within 5 days of contact, we ask that they notify the research team. • If the data collection is completed online, it will be using the Zoom platform, which is a video-conferencing service. Access to the Zoom platform will require a device capable of video conferencing, a stable internet connection, and a private space to partake in the study. • The first interview will take about 1-1.5 hours. We might ask if your child would like to take part in a follow up interview. If so, we will decide that at the end of the first interview and the 2nd interview will not last more than an hour. • The in-person interview will be audio-recorded and notes will also be taken. After the interview, the researcher will transcribe the audio recording. If the interview takes place over Zoom, the conversation will be video and audio recorded for the purpose of the research project. Your child may turn their camera off, mute their audio, and change their display name on Zoom (for example, using a nickname). The audio and video recordings will be used so the researcher has an accurate transcription of the conversation to analyze. Only the data from Zoom recordings and not the audio and video recording themselves will be used for any future uses, including publications and/or presentations. • If you agree to your child taking part in the study, we will ask them to answer a background questionnaire before the interview. • After the interview is transcribed, the researcher will contact your child to give you an opportunity to review the transcript for accuracy, clarification, and need for any changes. This may take up to 30 minutes and will be done in person, over the phone, or via Zoom, their choice. If it is done over the phone or via Zoom, the transcript will be emailed to your child in advance via password protected file, so they have it in front of them to review while we talk with them. • Another component of the study will include reviewing and discussing with your child their Individual Education Plan (IEP). As their IEP reflects the mental health and/or academic support they are receiving at school, it will be informative to review the support they are receiving and how it meets their needs. • In addition, with you and your child’s permission, Ms. Ruddy will attend one of their Individual Education Plan meetings. • Your child’s participation in the study is voluntary. Your child may stop their participation without repercussion up until the analysis of the data for the research project is done. Study Outcomes • Your child taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in presentations or publications 260 (e.g., journal articles, a report, a summary) without the inclusion of any information that would identify your child. • Data from this research project used in presentations or publications may be freely accessed by the public. Once the data is made available in this way, your child will not be able to withdraw their data. What are the risks of participating? • The only risk associated with participating in the study is that it is possible that your child may feel uncomfortable by some of the questions that are asked. If your child feels uncomfortable, they may choose to stop at any time. If any of the questions in the interview make them feel uncomfortable, they may choose not to respond to those questions. You and your child are welcome to contact us with any questions. If questions during the interview raises issues or feelings that your child would like support in dealing with, the researcher will provide them with community resources that they can access and will provide them with any support in accessing those services. What are the benefits of participating? • There are no explicit benefits to your child by taking part in this study. However, their participation will provide them with the opportunity to voice their opinion on their experiences and perceptions about how their school supports their mental health needs. Their participation will contribute towards developing a better understanding of how their school supports students’ mental health. How will my child’s identity and information remain confidential? • The information your child gives us is strictly confidential. No individual information will be reported and no participant or their school will be identified by name in any reports about the study. All paper data files collected will be stored in a locked filing cabinet in the lab and electronic and digital files will be password protected and encrypted at the university office of the researchers on the UBC Vancouver campus. Audio and video recordings from Zoom will be stored on UBC’S licensed Zoom cloud server. These files will be kept for a minimum of 5 years after the completion of the study and presentation or publication of results. At the end of the 5-year period, if there is no need for the data, paper copies may be shredded, and electronic and digital files will be deleted. • The only people who will have access to the information your child gives us are the researchers working on this study. All of the information from our conversations will be kept safe and secure. Contact for concerns or complaints about the study: • If you have any questions you can talk with us anytime. We can talk with you in person, or you can call us/email us. Our emails and phone numbers are written at the top of this letter. • If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598. 261 Consent for your Child to Participate in this Research Project By signing below, it means you consent (want) to your child to take part in this research study. Their participation in the study is entirely voluntary and they may stop their participation without repercussion up until the analysis of the data for the research project is done. When you sign below it also means that you have received a copy of this consent form for your own records. Once you have signed the consent form, please return your form directly to Alexandra Ruddy by: • Email at XXXXX@XXX.XX • Placing it in the designated box at the main office of XXXXX Secondary I CONSENT ________________________________ Your Name (Please Print) ____________________________________________________________ Your Signature Date I DO NOT CONSENT ________________________________ Your Name (Please Print) ____________________________________________________________ Your Signature Date Please also indicate whether you consent or do not consent to the following: Please indicate if you agree to your child being audio recorded: _____Yes _____ No 262 If the interview takes place over Zoom, please indicate if you agree to your child being video recorded: _____ Yes _____ No Please indicate if you agree to provide your child’s Individual Education Plan for review: _____ Yes _____ No Please indicate if you agree to have Ms. Ruddy attend one of your child’s Individual Education Plan (IEP) meetings: _____ Yes _____No 263 School-Based Support For Students With Identified Mental Health Concerns: A Case Study Student Consent for Interview Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear Student, Please read the following carefully. We are asking you to take part in the study we are doing with your high school. If, after reading this letter, you would like to take part in this research study, please sign one copy and keep the other copy for yourself. What is this study about? We would like to explore and understand the ways in which your high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews and the information we learn will be used for Ms. Ruddy’s dissertation. What happens if you want to participate in this study? • Participating in the study means that you will take part in a one-on-one interview to discuss your perceptions and experiences about how your identified mental health needs have been addressed and supported at your school. • Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to the participant. • If the interview takes place in-person, the location will be a quiet and private place such as a room in your school, a community centre, or a public library. A place that works well for you. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use 264 of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. • Before in-person research, we will ask participants a pre-determined series of health-related questions for COVID-19 screening. If you develop symptoms within 5 days of contact, we ask that you notify the research team. • If the data collection is completed online, it will be using the Zoom platform, which is a video-conferencing service. Access to the Zoom platform will require a device capable of video conferencing, a stable internet connection, and a private space to partake in the study. • The first interview will take about 1-1.5 hours. We might ask if you would like to take part in a follow up interview. If so, we will decide that at the end of the first interview and the 2nd interview will not last more than an hour. • The in-person interview will be audio-recorded and notes will also be taken. After the interview, the researcher will transcribe the audio recording. If the interview takes place over Zoom, the conversation will be video and audio recorded for the purpose of the research project. You may turn your camera off, mute your audio, and change your display name on Zoom (for example, using a nickname). The audio and video recordings will be used so the researcher has an accurate transcription of the conversation to analyze. Only the data from Zoom recordings and not the audio and video recording themselves will be used for any future uses, including publications and/or presentations. • If you agree to take part in the study, we will ask you to answer a background questionnaire before the interview. • After the interview is transcribed, the researcher will contact you to give you an opportunity to review the transcript for accuracy, clarification, and need for any changes. This may take up to 30 minutes and will be done in person, over the phone, or via Zoom, your choice. If it is done over the phone or via Zoom, the transcript will be emailed to you in advance via password protected file, so you have it in front of you to review while we talk with you. • Another component of the study will include reviewing and discussing with you your Individual Education Plan (IEP). As your IEP reflects the mental health and/or academic support you are receiving at school, it will be informative to review the support you are receiving and how it meets your needs. • In addition, with your permission, Ms. Ruddy will attend one of your IEP meetings. • Participation in the study is voluntary. You may stop your participation without repercussion up until the analysis of the data for the research project is done. Study Outcomes • Taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in presentations or publications (e.g., 265 journal articles, a report, a summary) without the inclusion of any information that would identify you. • Data from this research project used in presentations or publications may be freely accessed by the public. Once the data is made available in this way, you will not be able to withdraw your data. What are the risks of participating? • The only risk associated with participating in the study is that it is possible that you may feel uncomfortable by some of the questions that are asked. If you feel uncomfortable, you may choose to stop at any time. If any of the questions in the interview make you feel uncomfortable, you may choose not to respond to those questions. You are welcome to contact us with any questions. If questions during the interview raises issues or feelings that you would like support in dealing with, the researcher will provide you with community resources that you can access and will provide you with any support in accessing those services. What are the benefits of participating? • There are no explicit benefits to you by taking part in this study. However, your participation will provide you with the opportunity to voice your opinion on your experiences and perceptions about how your school supports your mental health needs. Your participation will contribute towards developing a better understanding of how your school supports students’ mental health. How will my identity and information remain confidential? • The information you give us is strictly confidential. No individual information will be reported and no participant or their school will be identified by name in any reports about the study. All paper data files collected will be stored in a locked filing cabinet in the lab and electronic and digital files will be password protected and encrypted at the university office of the researchers on the UBC Vancouver campus. Audio and video recordings from Zoom will be stored on UBC’S licensed Zoom cloud server. These files will be kept for a minimum of 5 years after the completion of the study and presentation or publication of results. At the end of the 5-year period, if there is no need for the data, paper copies may be shredded, and electronic and digital files will be deleted. • The only people who will have access to the information you give us are the researchers working on this study. All of the information from our conversations will be kept safe and secure. Contact for concerns or complaints about the study: • If you have any questions you can talk with us anytime. We can talk with you in person, or you can call us/email us. Our emails and phone numbers are written at the top of this letter. • If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598. 266 Consent to Participate in this Research Project By signing below, it means you consent (want) to take part in this research study. Your participation in the study is entirely voluntary and you may stop your participation without repercussion up until the analysis of the data for the research project is done. When you sign below it also means that you have received a copy of this consent form for your own records. Once you have signed the consent form, please return your form directly to Alexandra Ruddy by: • Email at XXXX@XXXX.XXX • Placing it in the designated box at the main office of XXXXX Secondary ________________________________ Your Name (Please Print) ____________________________________________________________ Your Signature Date Please indicate whether you consent or do not consent to the following: Please indicate if you agree to be audio recorded: Yes ______ No If the interview takes place over Zoom, please indicate if you agree to be video recorded: _____ Yes _____ No Please indicate if you agree to provide your Individual Education Plan for review: _____ Yes _____ No Please indicate if you agree to have Ms. Ruddy attend one of your Individual Education Plan (IEP) meetings: _____ Yes _____No 267 School-Based Support For Students With Identified Mental Health Concerns: A Case Study School Personnel Consent for Interview Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear School Personnel, Please read the following carefully. We are asking you to take part in the study we are doing with the high school at which you work. If, after reading this letter, you would like to take part in this research study, please sign one copy and keep the other copy for yourself. What is this study about? We would like to explore and understand the ways in which your high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews and the information we learn will be used for Ms. Ruddy’s dissertation. What happens if you want to participate in this study? • Participating in the study means that you will take part in a one-on-one interview about your perceptions and experiences about how students’ identified mental health needs have been addressed and supported at your school. • Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to the participant. • If the interview takes place in-person, the location will be a quiet and private place such as a room in your school, a community centre, or a public library. A place that works well for you. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use 268 of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. • Before in-person research, we will ask participants a pre-determined series of health-related questions for COVID-19 screening. If you develop symptoms within 5 days of contact, we ask that you notify the research team. • If the data collection is completed online, it will be using the Zoom platform, which is a video-conferencing service. Access to the Zoom platform will require a device capable of video conferencing, a stable internet connection, and a private space to partake in the study. • The first interview will take about 1-1.5 hours. We might ask if you would like to take part in a follow up interview. If so, we will decide that at the end of the first interview and the 2nd interview will not last more than an hour. • The in-person interview will be audio-recorded and notes will also be taken. After the interview, the researcher will transcribe the audio recording. If the interview takes place over Zoom, the conversation will be video and audio recorded for the purpose of the research project. You may turn your camera off and change your display name on Zoom (for example, using a nickname). The audio and video recordings will be used so the researcher has an accurate transcription of the conversation to analyze. Only the data from Zoom recordings and not the audio and video recording themselves will be used for any future uses, including publications and/or presentations. • If you agree to take part in the study, we will ask you to answer a background questionnaire before the interview. • After the interview is transcribed, the researcher will contact you to give you an opportunity to review the transcript for accuracy, clarification, and need for any changes. This may take up to 30 minutes and will be done in person, over the phone, or via Zoom, your choice. If it is done over the phone or via Zoom, the transcript will be emailed to you in advance via password protected file, so you have it in front of you to review while we talk with you. • Participation in the study is voluntary. You may stop your participation without repercussion up until the analysis of the data for the research project is done. Study Outcomes • Taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in presentations or publications (e.g., journal articles, a report, a summary) without the inclusion of any information that would identify you. • Data from this research project used in presentations or publications may be freely accessed by the public. Once the data is made available in this way, you will not be able to withdraw your data. What are the risks of participating? 269 • The only risk associated with participating in the study is that it is possible that you may feel uncomfortable by some of the questions that are asked. If you feel uncomfortable, you may choose to stop at any time. If any of the questions in the interview make you feel uncomfortable, you may choose not to respond to those questions. You are welcome to contact us with any questions. If questions during the interview raises issues or feelings that you would like support in dealing with, the researcher will provide you with community resources that you can access and will provide you with any support in accessing those services. What are the benefits of participating? • There are no explicit benefits to you by taking part in this study. However, your participation will provide you with the opportunity to voice your opinion on your experiences and perceptions about how your school supports student mental health needs. Your participation will contribute towards developing a better understanding of how your school supports students’ mental health. How will my identity and information remain confidential? • The information you give us is strictly confidential. No individual information will be reported and no participant or their school will be identified by name in any reports about the study. All paper data files collected will be stored in a locked filing cabinet in the lab and electronic and digital files will be password protected and encrypted at the university office of the researchers on the UBC Vancouver campus. Audio and video recordings from Zoom will be stored on UBC’S licensed Zoom cloud server. These files will be kept for a minimum of 5 years after the completion of the study and presentation or publication of results. At the end of the 5-year period, if there is no need for the data, paper copies may be shredded, and electronic and digital files will be deleted. • The only people who will have access to the information you give us are the researchers working on this study. All of the information from our conversations will be kept safe and secure. Contact for concerns or complaints about the study: • If you have any questions you can talk with us anytime. We can talk with you in person, or you can call us/email us. Our emails and phone numbers are written at the top of this letter. • If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598. 270 Consent to Participate in this Research Project By signing below, it means you consent (want) to take part in this research study. Your participation in the study is entirely voluntary and you may stop your participation without repercussion up until the analysis of the data for the research project is done. When you sign below it also means that you have received a copy of this consent form for your own records. Once you have signed the consent form, please return your form directly to Alexandra Ruddy by: • Email at XXXXX@XXX.XX • Placing it in the designated box at the main office of XXXXX Secondary ________________________________ Your Name (Please Print) ____________________________________________________________ Your Signature Date Please indicate whether you consent or do not consent to the following: Please indicate if you agree to be audio recorded: Yes ______ No If the interview takes place over Zoom, please indicate if you agree to be video recorded: _____ Yes _____ No 271 School-Based Support For Students With Identified Mental Health Concerns: A Case Study School Mental Health Professional Consent Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear School Mental Health Professional, Please read the following carefully. We are asking you to take part in the study we are doing with the high school at which you work. If, after reading this letter, you would like to take part in this research study, please sign one copy and keep the other copy for yourself. What is this study about? We would like to explore and understand the ways in which your high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews and the information we learn will be used for Ms. Ruddy’s dissertation. What happens if you want to participate in this study? • Participating in the study means that you will take part in a one-on-one interview about your perceptions and experiences about how students’ identified mental health needs have been addressed and supported at your school. • Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to the participant. • If the interview takes place in-person, the location will be a quiet and private place such as a room in your school, a community centre, or a public library. A place that works well for you. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use 272 of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. • Before in-person research, we will ask participants a pre-determined series of health-related questions for COVID-19 screening. If you develop symptoms within 5 days of contact, we ask that you notify the research team. • If the data collection is completed online, it will be using the Zoom platform, which is a video-conferencing service. Access to the Zoom platform will require a device capable of video conferencing, a stable internet connection, and a private space to partake in the study. • The first interview will take about 1-1.5 hours. We might ask if you would like to take part in a follow up interview. If so, we will decide that at the end of the first interview and the 2nd interview will not last more than an hour. • The in-person interview will be audio-recorded and notes will also be taken. After the interview, the researcher will transcribe the audio recording. If the interview takes place over Zoom, the conversation will be video and audio recorded for the purpose of the research project. You may turn your camera off and change your display name on Zoom (for example, using a nickname). The audio and video recordings will be used so the researcher has an accurate transcription of the conversation to analyze. Only the data from Zoom recordings and not the audio and video recording themselves will be used for any future uses, including publications and/or presentations. • If you agree to take part in the study, we will ask you to answer a background questionnaire before the interview. • After the interview is transcribed, the researcher will contact you to give you an opportunity to review the transcript for accuracy, clarification, and need for any changes. This may take up to 30 minutes and will be done in person, over the phone, or via Zoom, your choice. If it is done over the phone or via Zoom, the transcript will be emailed to you in advance via password protected file, so you have it in front of you to review while we talk with you. • Participation in the study is voluntary. You may stop your participation without repercussion up until the analysis of the data for the research project is done. Study Outcomes • Taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in presentations or publications (e.g., journal articles, a report, a summary) without the inclusion of any information that would identify you. • Data from this research project used in presentations or publications may be freely accessed by the public. Once the data is made available in this way, you will not be able to withdraw your data. What are the risks of participating? 273 • The only risk associated with participating in the study is that it is possible that you may feel uncomfortable by some of the questions that are asked. If you feel uncomfortable, you may choose to stop at any time. If any of the questions in the interview make you feel uncomfortable, you may choose not to respond to those questions. You are welcome to contact us with any questions. If questions during the interview raises issues or feelings that you would like support in dealing with, the researcher will provide you with community resources that you can access and will provide you with any support in accessing those services. What are the benefits of participating? • There are no explicit benefits to you by taking part in this study. However, your participation will provide you with the opportunity to voice your opinion on your experiences and perceptions about how your school supports student mental health needs. Your participation will contribute towards developing a better understanding of how your school supports students’ mental health. How will my identity and information remain confidential? • The information you give us is strictly confidential. No individual information will be reported and no participant or their school will be identified by name in any reports about the study. All paper data files collected will be stored in a locked filing cabinet in the lab and electronic and digital files will be password protected and encrypted at the university office of the researchers on the UBC Vancouver campus. Audio and video recordings from Zoom will be stored on UBC’S licensed Zoom cloud server. These files will be kept for a minimum of 5 years after the completion of the study and presentation or publication of results. At the end of the 5-year period, if there is no need for the data, paper copies may be shredded, and electronic and digital files will be deleted. • The only people who will have access to the information you give us are the researchers working on this study. All of the information from our conversations will be kept safe and secure. Contact for concerns or complaints about the study: • If you have any questions you can talk with us anytime. We can talk with you in person, or you can call us/email us. Our emails and phone numbers are written at the top of this letter. • If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598. 274 Consent to Participate in this Research Project By signing below, it means you consent (want) to take part in this research study. Your participation in the study is entirely voluntary and you may stop your participation without repercussion up until the analysis of the data for the research project is done. When you sign below it also means that you have received a copy of this consent form for your own records. Once you have signed the consent form, please return your form directly to Alexandra Ruddy by: • Email at XXXX@XXX.XX • Placing it in the designated box at the main office of XXXXX Secondary ________________________________ Your Name (Please Print) ____________________________________________________________ Your Signature Date Please also indicate whether you consent or do not consent to the following: Please indicate if you agree to be audio recorded: Yes ______ No If the interview takes place over Zoom, please indicate if you agree to be video recorded: _____ Yes _____ No 275 School-Based Support For Students With Identified Mental Health Concerns: A Case Study Community Mental Health Professional Consent Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear Mental Health Professional in the Community, Please read the following carefully. We are asking you to take part in the study we are doing with a high school in your community. If, after reading this letter, you would like to take part in this research study, please sign one copy and keep the other copy for yourself. What is this study about? We would like to explore and understand the ways in which this particular high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what this school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews and the information we learn will be used for Ms. Ruddy’s dissertation. What happens if you want to participate in this study? • Participating in the study means that you will take part in a one-on-one interview about your perceptions and experiences about how student mental health has been addressed and supported at this school. • Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to the participant. • If the interview takes place in-person, the location will be a quiet and private place such as a room in the school, a community centre, or a public library. A place that works well for you. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use 276 of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. • Before in-person research, we will ask participants a pre-determined series of health-related questions for COVID-19 screening. If you develop symptoms within 5 days of contact, we ask that you notify the research team. • If the data collection is completed online, it will be using the Zoom platform, which is a video-conferencing service. Access to the Zoom platform will require a device capable of video conferencing, a stable internet connection, and a private space to partake in the study. • The first interview will take about 1-1.5 hours. We might ask if you would like to take part in a follow up interview. If so, we will decide that at the end of the first interview and the 2nd interview will not last more than an hour. • The in-person interview will be audio-recorded and notes will also be taken. After the interview, the researcher will transcribe the audio recording. If the interview takes place over Zoom, the conversation will be video and audio recorded for the purpose of the research project. You may turn your camera off, mute your audio, and change your display name on Zoom (for example, using a nickname). The audio and video recordings will be used so the researcher has an accurate transcription of the conversation to analyze. Only the data from Zoom recordings and not the audio and video recording themselves will be used for any future uses, including publications and/or presentations. • If you agree to take part in the study, we will ask you to answer a background questionnaire before the interview. • After the interview is transcribed, the researcher will contact you to give you an opportunity to review the transcript for accuracy, clarification, and need for any changes. This may take up to 30 minutes and will be done in person, over the phone, or via Zoom, your choice. If it is done over the phone or via Zoom, the transcript will be emailed to you in advance via password protected file, so you have it in front of you to review while we talk with you. • Participation in the study is voluntary. You may stop your participation without repercussion up until the analysis of the data for the research project is done. Study Outcomes • Taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in presentations or publications (e.g., journal articles, a report, a summary) without the inclusion of any information that would identify you. • Data from this research project used in presentations or publications may be freely accessed by the public. Once the data is made available in this way, you will not be able to withdraw your data. 277 What are the risks of participating? • The only risk associated with participating in the study is that it is possible that you may feel uncomfortable by some of the questions that are asked. If you feel uncomfortable, you may choose to stop at any time. If any of the questions in the interview make you feel uncomfortable, you may choose not to respond to those questions. You are welcome to contact us with any questions. If questions during the interview raises issues or feelings that you would like support in dealing with, the researcher will provide you with community resources that you can access and will provide you with any support in accessing those services. What are the benefits of participating? • There are no explicit benefits to you by taking part in this study. However, your participation will provide you with the opportunity to voice your opinion on your experiences and perceptions about how this school supports student mental health needs. Your participation will contribute towards developing a better understanding of how this school supports students’ mental health. How will my identity and information remain confidential? • The information you give us is strictly confidential. No individual information will be reported and no participant or their school will be identified by name in any reports about the study. All paper data files collected will be stored in a locked filing cabinet in the lab and electronic and digital files will be password protected and encrypted at the university office of the researchers on the UBC Vancouver campus. Audio and video recordings from Zoom will be stored on UBC’S licensed Zoom cloud server. These files will be kept for a minimum of 5 years after the completion of the study and presentation or publication of results. At the end of the 5-year period, if there is no need for the data, paper copies may be shredded, and electronic and digital files will be deleted. • The only people who will have access to the information you give us are the researchers working on this study. All of the information from our conversations will be kept safe and secure. Contact for concerns or complaints about the study: • If you have any questions you can talk with us anytime. We can talk with you in person, or you can call us/email us. Our emails and phone numbers are written at the top of this letter. • If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598. 278 Consent to Participate in this Research Project By signing below, it means you consent (want) to take part in this research study. Your participation in the study is entirely voluntary and you may stop your participation without repercussions up until the analysis of the data for the research project is done. When you sign below it also means that you have received a copy of this consent form for your own records. Once you have signed the consent form, please return your form directly to Alexandra Ruddy by: • Email at XXXX@XXX.XXX • Placing it in the designated box at the main office of XXXXX Secondary ________________________________ Your Name (Please Print) ____________________________________________________________ Your Signature Date Please indicate whether you consent or do not consent to the following: Please indicate if you agree to be audio recorded: Yes ______ No If the interview takes place over Zoom, please indicate if you agree to be video recorded: _____ Yes _____ No 279 School-Based Support For Students With Identified Mental Health Concerns: A Case Study School Administrator Consent for Interview Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear School Administrator, Please read the following carefully. We are asking you to take part in the study we are doing with the high school at which you work. If, after reading this letter, you would like to take part in this research study, please sign one copy and keep the other copy for yourself. What is this study about? We would like to explore and understand the ways in which your high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews and the information we learn will be used for Ms. Ruddy’s dissertation. What happens if you want to participate in this study? • Participating in the study means that you will take part in a one-on-one interview about your perceptions and experiences about how students’ mental health needs have been addressed and supported at your school. • Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to the participant. • If the interview takes place in-person, the location will be a quiet and private place such as a room in your school, a community centre, or a public library. A place that works well for you. For in-person data collection, the researcher will follow appropriate procedures 280 outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. • Before in-person research, we will ask participants a pre-determined series of health-related questions for COVID-19 screening. If you develop symptoms within 5 days of contact, we ask that you notify the research team. • If the data collection is completed online, it will be using the Zoom platform, which is a video-conferencing service. Access to the Zoom platform will require a device capable of video conferencing, a stable internet connection, and a private space to partake in the study. • The first interview will take about 1-1.5 hours. We might ask if you would like to take part in a follow up interview. If so, we will decide that at the end of the first interview and the 2nd interview will not last more than an hour. • The in-person interview will be audio-recorded and notes will also be taken. After the interview, the researcher will transcribe the audio recording. If the interview takes place over Zoom, the conversation will be video and audio recorded for the purpose of the research project. You may turn your camera off, mute your audio, and change your display name on Zoom (for example, using a nickname). The audio and video recordings will be used so the researcher has an accurate transcription of the conversation to analyze. Only the data from Zoom recordings and not the audio and video recording themselves will be used for any future uses, including publications and/or presentations. • If you agree to take part in the study, we will ask you to answer a background questionnaire before the interview. • After the interview is transcribed, the researcher will contact you to give you an opportunity to review the transcript for accuracy, clarification, and need for any changes. This may take up to 30 minutes and will be done in person, over the phone, or via Zoom, your choice. If it is done over the phone or via Zoom, the transcript will be emailed to you in advance via password protected file, so you have it in front of you to review while we talk with you. • Participation in the study is voluntary. You may stop your participation without repercussion up until the analysis of the data for the research project is done. Study Outcomes • Taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in presentations or publications (e.g., journal articles, a report, a summary) without the inclusion of any information that would identify you. • Data from this research project used in presentations or publications may be freely accessed by the public. Once the data is made available in this way, you will not be able to withdraw your data. 281 What are the risks of participating? • The only risk associated with participating in the study is that it is possible that you may feel uncomfortable by some of the questions that are asked. If you feel uncomfortable, you may choose to stop at any time. If any of the questions in the interview make you feel uncomfortable, you may choose not to respond to those questions. You are welcome to contact us with any questions. If questions during the interview raises issues or feelings that you would like support in dealing with, the researcher will provide you with community resources that you can access and will provide you with any support in accessing those services. What are the benefits of participating? • There are no explicit benefits to you by taking part in this study. However, your participation will provide you with the opportunity to voice your opinion on your experiences and perceptions about how your school supports student mental health needs. Your participation will contribute towards developing a better understanding of how your school supports students’ mental health. How will my identity and information remain confidential? • The information you give us is strictly confidential. No individual information will be reported and no participant or their school will be identified by name in any reports about the study. All paper data files collected will be stored in a locked filing cabinet in the lab and electronic and digital files will be password protected and encrypted at the university office of the researchers on the UBC Vancouver campus. Audio and video recordings from Zoom will be stored on UBC’S licensed Zoom cloud server. These files will be kept for a minimum of 5 years after the completion of the study and presentation or publication of results. At the end of the 5-year period, if there is no need for the data, paper copies may be shredded, and electronic and digital files will be deleted. • The only people who will have access to the information you give us are the researchers working on this study. All of the information from our conversations will be kept safe and secure. Contact for concerns or complaints about the study: • If you have any questions you can talk with us anytime. We can talk with you in person, or you can call us/email us. Our emails and phone numbers are written at the top of this letter. • If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598. 282 Consent to Participate in this Research Project By signing below, it means you consent (want) to take part in this research study. Your participation in the study is entirely voluntary and you may stop your participation without repercussion up until the analysis of the data for the research project is done. When you sign below it also means that you have received a copy of this consent form for your own records. Once you have signed the consent form, please return your form directly to Alexandra Ruddy by: • Email at XXXX@XXX.XXX • Placing it in the designated box at the main office of XXXXX Secondary ________________________________ Your Name (Please Print) ____________________________________________________________ Your Signature Date Please indicate whether you consent or do not consent to the following: Please indicate if you agree to be audio recorded: Yes ______ No If the interview takes place over Zoom, please indicate if you agree to be video recorded: _____ Yes _____ No 283 Appendix E: Student Assent Form School-Based Support For Students With Identified Mental Health Concerns: A Case Study Student Assent for Interview Principal Investigator: Laurie Ford, Ph.D. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX Student Co-Investigator: Alexandra Ruddy, M.A. Department of Educational & Counselling Psychology & Special Education Phone: XXX-XXX-XXXX Email: XXXX@XXX.XXX ____________________________________________________________________________ Dear Student, Please read the following carefully. We are asking you to take part in the study we are doing with your high school. If, after reading this letter, you would like to take part in this research study, please sign one copy and keep the other copy for yourself. What is this study about? We would like to explore and understand the ways in which your high school supports student mental health. With the rise of students experiencing mental health concerns, it is important that schools support them in ways that meet both their mental health and academic needs. It is also important to understand the ways in which these students and their unique needs are potentially impacting schools. The perceptions and experiences of people within the school community (i.e., students, parents, teachers, mental health professionals, administrators, etc.) will provide a better and more complete understanding of what your school is doing well and what can be improved when it comes to meeting the needs of students struggling with their mental health. This information will be gathered through individual and group interviews and the information we learn will be used for Ms. Ruddy’s dissertation. What happens if you want to participate in this study? • Participating in the study means that you will take part in a one-on-one interview to discuss your perceptions and experiences about how your identified mental health needs have been addressed and supported at your school. • Due to the changing nature of the COVID-19 pandemic, the interview will take place either online via Zoom or in-person at a location in the community that we mutually agree upon. The decision to do the interview in-person or online via Zoom will be up to the participant. • If the interview takes place in-person, the location will be a quiet and private place such as a room in your school, a community centre, or a public library. A place that works well 284 for you. For in-person data collection, the researcher will follow appropriate procedures outlined by the UBC Office of Research Ethics, BC Public Health Officer, and the School District to reduce the risk of COVID-19 transmission. These procedures include the use of N95 or KN95 masks for all in-person research and limiting in-person research as much as possible (e.g., conducting focus groups online via zoom). The research team is also fully vaccinated and able to provide proof of vaccination. • Before in-person research, we will ask participants a pre-determined series of health-related questions for COVID-19 screening. If you develop symptoms within 5 days of contact, we ask that you notify the research team. • If the data collection is completed online, it will be using the Zoom platform, which is a video-conferencing service. Access to the Zoom platform will require a device capable of video conferencing, a stable internet connection, and a private space to partake in the study. • The first interview will take about 1-1.5 hours. We might ask if you would like to take part in a follow up interview. If so, we will decide that at the end of the first interview and the 2nd interview will not last more than an hour. • The in-person interview will be audio-recorded and notes will also be taken. After the interview, the researcher will transcribe the audio recording. If the interview takes place over Zoom, the conversation will be video and audio recorded for the purpose of the research project. You may turn your camera off, mute your audio, and change your display name on Zoom (for example, using a nickname). The audio and video recordings will be used so the researcher has an accurate transcription of the conversation to analyze. Only the data from Zoom recordings and not the audio and video recording themselves will be used for any future uses, including publications and/or presentations. • If you agree to take part in the study, we will ask you to answer a background questionnaire before the interview. • After the interview is transcribed, the researcher will contact you to give you an opportunity to review the transcript for accuracy, clarification, and need for any changes. This may take up to 30 minutes and will be done in person, over the phone, or via Zoom, your choice. If it is done over the phone or via Zoom, the transcript will be emailed to you in advance via password protected file, so you have it in front of you review while we talk with you. • Another component of the study will include reviewing and discussing with you your Individual Education Plan (IEP). As your IEP reflects the mental health and/or academic support you are receiving at school, it will be informative to review the support you are receiving and how it meets your needs. • In addition, with your permission, Ms. Ruddy will attend one of your IEP meetings. • Participation in the study is voluntary. You may stop your participation without repercussion up until the analysis of the data for the research project is done. 285 Study Outcomes • Taking part in the study means that you agree to the information being used for the purpose of reporting the results of the research in presentations or publications (e.g., journal articles, a report, a summary) without the inclusion of any information that would identify you. • Data from this research project used in presentations or publications may be freely accessed by the public. Once the data is made available in this way, you will not be able to withdraw your data. What are the risks of participating? • The only risk associated with participating in the study is that it is possible that you may feel uncomfortable by some of the questions that are asked. If you feel uncomfortable, you may choose to stop at any time. If any of the questions in the interview make you feel uncomfortable, you may choose not to respond to those questions. You are welcome to contact us with any questions. If questions during the interview raises issues or feelings that you would like support in dealing with, the researcher will provide you with community resources that you can access and will provide you with any support in accessing those services. What are the benefits of participating? • There are no explicit benefits to you by taking part in this study. However, your participation will provide you with the opportunity to voice your opinion on your experiences and perceptions about how your school supports your mental health needs. Your participation will contribute towards developing a better understanding of how your school supports students’ mental health. How will my identity and information remain confidential? • The information you give us is strictly confidential. No individual information will be reported and no participant or their school will be identified by name in any reports about the study. All paper data files collected will be stored in a locked filing cabinet in the lab and electronic and digital files will be password protected and encrypted at the university office of the researchers on the UBC Vancouver campus. Audio and video recordings from Zoom will be stored on UBC’S licensed Zoom cloud server. These files will be kept for a minimum of 5 years after the completion of the study and presentation or publication of results. At the end of the 5-year period, if there is no need for the data, paper copies may be shredded, and electronic and digital files will be deleted. • The only people who will have access to the information you give us are the researchers working on this study. All of the information from our conversations will be kept safe and secure. Contact for concerns or complaints about the study: • If you have any questions you can talk with us anytime. We can talk with you in person, or you can call us/email us. Our emails and phone numbers are written at the top of this letter. • If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research 286 Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598. Assent to Participate in this Research Project By signing below, it means you assent (want) to take part in this research study. Your participation in the study is entirely voluntary and you may stop your participation without repercussion up until the analysis of the data for the research project is done. When you sign below it also means that you have received a copy of this consent form for your own records. Once you have signed the consent form, please return your form directly to Alexandra Ruddy by: • Email at XXXX@XXX.XXXX • Placing it in the designated box at the main office of XXXXX Secondary ________________________________ Your Name (Please Print) ____________________________________________________________ Your Signature Date Please indicate whether you consent or do not consent to the following: Please indicate if you agree to be audio recorded: Yes ______ No If the interview takes place over Zoom, please indicate if you agree to be video recorded: _____ Yes _____ No Please indicate if you agree to provide your Individual Education Plan for review: _____ Yes _____ No 287 Please indicate if you agree to have Ms. Ruddy attend one of your Individual Education Plan (IEP) meetings: _____ Yes _____No 288 Appendix F: Background Questionnaires General Education Students 1. What gender do you identify as? 2. How old are you? 3. What grade are you in? 4. How many years have you attended your secondary school? Students with a Designation 1. What gender do you identify as? 2. How old are you? 3. What grade are you in? 4. How many years have you attended your secondary school? 5. What is your designation? a. Please specify the reason you have that designation. b. How long have you had this designation? Parents 1. What gender do you identify as? 2. How old is your child? 3. What grade is your child in? 4. How many years has your child attended this school? 5. What is your child’s designation? a. Please specify the reason for their designation. b. How long have they had this designation? 289 Special Education Teachers 1. What gender do you identify as? 2. In which grade(s) are the students you work with? 3. How many years of experience do you have as teacher? 4. How many years of experience do you have as a special education teacher? 5. How many years have you taught at this school? General Education Teachers 1. What gender do you identify as? 2. Which grades and classes do you teach? 3. How many years of experience do you have as teacher? 4. How many years have you taught at this school? Educational Assistants 1. What gender do you identify as? 2. In which grades are the students you work with? 3. How many years of experience do you have as an educational assistant? 4. How many years have you worked at this school? School Counsellor and School Psychologist 1. What gender do you identify as? 2. How many years of experience do you have as a school counsellor/school psychologist? 3. How many years have you been working at this school? Youth Engagement Worker 1. What gender do you identify as? 2. How many years of experience do you have as a school counsellor/school psychologist? 290 3. How many years have you been working at this school? School Administrators 1. What gender do you identify as? 2. How many years of experience do you have as an educator? 3. How many years of experience do you have as a school administrator? 4. How many years have you been working at this school? 291 Appendix G: Interview Questions Students with a Mental Health Diagnosis and Designation (Adapted from Cooper (2019), Ruddy (2019) and Semchuk (2016)) 1. Tell me about your school. a. How is this school year going? 2. Tell me about your experience at school with having a designation for ____ (or mental illness). a. For how long have you had this designation? b. In what ways do your mental health challenges impact your functioning at school? 3. What was the process to receive a designation and receive support at school? a. How did you end up getting support? b. How do you think being identified as a student with mental health concerns supports you? c. What does it meant to you to have this designation? 4. What are/were the barriers for you in accessing mental health services at your school? 5. What does getting support for ______ at school mean to you? 6. What are your biggest needs at school?/ What do you feel you need support with at school? a. What are your biggest stressors at school? 7. As a student with this designation, how do you feel supported at school? a. What kind of supports do you receive? What do those look like? i. Who is involved in providing support? ii. Where do you go at school to receive support? 292 iii. If you are in need of support, what do you do to find or obtain support? b. How do you know what supports are available? c. What has your experience been like receiving these supports at school? d. How do the supports that you receive at school meet your needs? i. Do you feel that the current practices and procedures of your school meet your needs? 8. I would like to ask you some questions specifically about your Individual Education Plan or IEP. Tell me what you know about an IEP (purpose, goal)? a. Tell me about your IEP. b. What is your experience with having an IEP? c. How do you feel about your IEP? i. To what extent do you feel that you are part of developing your IEP? ii. Is your IEP helpful? Why or Why not? iii. Does your IEP meet your specific needs? iv. To what extent are you satisfied with your IEP? d. Do you attend your IEP meetings? i. If so, tell me about those meetings. What is your role at the meeting? How do you contribute to the meeting? Who attends the meetings? ii. If not, why not? e. What changes, if any, would you make to your IEP document or to IEP meetings that you attend? 9. Do you think the school provides sufficient and adequate resources to support you as a student with identified mental health concerns? Why or why not? 293 10. How has COVID-19 impacted your experience with receiving supports at school? 11. What changes, if any, would you suggest or recommend to make yours or others’ who have mental health difficulties experiences at school better? a. Tell me about what you would like to continue seeing with regards to your support. b. Tell me if there was anything you would like done differently at school. 12. Is there anything else you would like me to know about your experience and the support you receive at school? 294 General Education Students (Adapted from Ruddy, 2019) 1. Tell me about your school. 2. Tell me about your experience at school. a. How is this school year going? 3. To what extent do you feel that staff and peers at school care about you as an individual, your academic success, and your overall wellbeing? a. Describe your relationships at school with peers and school staff. b. Tell me how you feel about your school. c. To what extent do you feel engaged with your school (e.g., how is your attendance, work complete, goal setting?) d. To what extent do you feel safe at school? 4. How important is it to you that your school addresses and supports student mental health? 5. What are the most common mental health issues or problems you’ve seen among students at this school? a. What do you perceive to be the major stressors for students that contribute to mental health difficulties? 6. Describe how mental health is discussed at school. a. In the class setting? Do you formally learn about mental health in class as part of the curriculum? b. Informally among students? 7. Do you feel that student mental health is a priority at your school? Why or why not? 8. How do you feel supported at school when it comes to your mental health? 295 9. Tell me about the mental health services at your school. a. What do you know about these services? b. Where did you learn about these services? c. Who provides these services? d. Are you aware as to whether students use these services or would use these services at school? e. Does your school have any initiatives or programs that target student mental health? If so, what are they? f. Do you think the available supports adequately meet the needs of students? 10. What do you know about how students who have been identified as having mental health concerns are supported at school? a. What kind of academic accommodations or other types of support do students who are experiencing mental health challenges receive? 11. Who/where would a student at your school turn to/ask for help or guidance if they had a difficulty in dealing with a mental health problem (at school)? (adapted from Chandra & Minkovitz, 2007) a. Why that person or place? b. (If student does not feel that there is a person or place to turn to), why not? 12. If teens like yourselves at your school were to seek mental health services, what do you think friends would say? Describe their reaction. (Chandra & Minkovitz, 2007) a. Describe the attitudes of those at your school around mental health. i. Students ii. Teachers 296 iii. Other school staff iv. Principal b. How comfortable do you think teens at your school would feel about openly discussing mental health challenges with: i. Peers ii. Teachers iii. Other school staff c. What do you think other students’ understanding is of mental health? 13. What are the barriers for students to access mental health services at your school? 14. Do you think the school provides sufficient and adequate resources to support students’ mental health, particularly students with identified mental health concerns? Why or why not? 15. How has COVID-19 impacted your or others’ experience with receiving mental health support at school? 16. What changes, if any, would you like to see in how your school addresses and supports student mental health? 17. Is there anything else you would like me to know about how your school addresses and supports mental health? 297 Parents of Students with a Designation 1. Tell me a bit about your child. a. Tell me about your child’s mental health difficulties. b. How were these concerns first identified? By whom? 2. What do you think might be contributing to these concerns? 3. What do you think your child needs support with at school? 4. Tell me about your relationship with your child’s school. 5. Tell me about the process of your child getting a designation. 6. What does it mean for your child to have a designation at school? 7. Tell me about your child’s support at school. a. What kind of support do they receive? What do those look like? b. Who is involved in providing supports? c. How do you feel that these supports meet your child’s needs? d. How has this support been helpful or useful? e. How has this support been unhelpful? 8. Tell me about your involvement in your child’s support at school. a. How do you feel involved in this support? b. Are there any changes you would make to your own involvement? 9. I would like to ask you some questions specifically about your child’s Individual Education Plan or IEP. a. Tell me what you know about an IEP. b. Tell me about your child’s IEP. c. What is your experience or involvement with your child’s IEP? 298 i. To what extent do you feel that you are part of developing your child’s IEP? ii. Is your child’s IEP helpful for your child? Why or Why not? iii. Does your IEP meet your child’s specific needs? iv. To what extent are you satisfied with your child’s IEP? d. Do you attend your child’s IEP meetings? i. If so, tell me about those meetings. What is your role at the meeting? How do you contribute to the meeting? Who attends the meetings? ii. If not, why not? e. What changes, if any, would you make to your child’s IEP document or to IEP meetings that you attend? 10. How has COVID-19 impacted your child’s experience with receiving supports at school? How has it impacted your involvement in the support? 11. Do you think the school provides sufficient and adequate resources to support your child with identified mental health concerns? Why or why not? 12. What changes, if any, would you suggest or recommend to the support your child receives at school? a. Tell me about what you would like to continue seeing with regards to your child’s support. b. Tell me if there is anything you would like done differently at the school with regards to your child’s support. 13. What changes, if any, would you suggest or recommend to make yours or other parents who have children with mental health difficulties experiences with the school better? 299 a. Tell me about what you would like to continue seeing with regards to your involvement in your child’s support. b. Tell me if there is anything you would like done differently at the school with regards to your involvement in that support. 14. Is there anything else you would like me to know about your experience and the support your child receives at school? 300 Parents of General Education Students 1. Tell me about your experience and relationship with your child’s school. a. Describe your relationships with your child’s teachers or other school personnel (e.g., EAs) b. Tell me how you feel about your child’s school. c. To what extent do you feel engaged with your child’s school? d. To what extent do you feel your child’s school provides a safe environment for your child? 2. Tell me about your involvement in your child’s school. a. Are there any changes you would make to your own involvement? 3. To what extent do you feel that administrators, staff, and other students at your child’s school care about your child as an individual, their academic success, and their overall wellbeing? 4. How important is it to you that your child’s school addresses and supports student mental health? 5. What do you perceive to be the major stressors for your child that contribute to mental health difficulties? 6. To your knowledge, describe how mental health is discussed at your child’s school. 7. Do you feel that student mental health is a priority at your child’s school? Why or why not? 8. How do you feel your child is supported at school when it comes to their mental health? 9. Tell me about the mental health services at your child’s school. a. What do you know about these services? 301 b. Where did you learn about these services? c. Who provides these services? d. Does your child’s school have any initiatives or programs that you are aware of that target student mental health? If so, what are they? e. Do you think the available supports adequately meets the needs of your child or other students? 10. What are the barriers for your child or other students to access mental health services at your child’s school? 11. What are the attitudes of students, staff and administrators at your child’s school around mental health? 12. Do you think the school provides sufficient and adequate resources to support students’ mental health, particularly students with identified mental health concerns? Why or why not? 13. How has COVID-19 impacted your child’s or others’ experience with receiving mental health support at school? 14. What changes, if any, would you like to see in how your child’s school addresses and supports student mental health? 15. Is there anything else you would like me to know about how your child’s school addresses and supports mental health? 302 Special Education Teachers 1. Tell me about your role as a special education teacher at your school. a. What are your responsibilities? b. How do you feel about these responsibilities? c. Are there any changes that you would make to these responsibilities? E.g., things you think you should be doing or things you do not think are your responsibility 2. To what extent do you believe addressing students’ mental health needs is part of your role? 3. What do you perceive to be the biggest mental health concerns among students at this school? a. What do you think contributes to these mental health concerns? What are some major stressors? b. What do you perceive students’ needs to be at school? 4. What do you think the role of the school is in supporting student mental health? 5. What does this school do to support the mental health of all students? a. What does this school do to support students with R/H/any designation? b. How has this support been impacted by COVID-19? 6. Thinking about the students you work with/at this school, what are the most important or biggest barriers for students to access mental health services? 7. Tell me about the process for a student to receive an R or H/any designation. a. What is your involvement in this process? b. What changes, if any, would you make to this process? 303 8. How do you think being identified as a student with mental health concerns supports students? a. Do you think a designation adequately supports students? 9. To your knowledge, what supports are specifically in place for these students? What does this school do to support the mental health of students identified as having mental health concerns (i.e., a designation in the R or H category)/having Q designations (learning disabilities)? a. Who is involved in providing these supports? b. Where do students go to receive support? c. If a student is in need of support, what do they do to find or obtain support? 10. How do you support students who are identified as having mental health concerns/how do you help support the mental health of the students you work with? a. Do you feel confident or qualified to support these students/student mental health? i. Why or why not? ii. What would you need to feel more confident or qualified? b. What hinders your ability to provide this support? c. What helps your ability to provide this support? 11. Tell me about your role in developing IEPs for students with an R or H designation/Q designation? a. What is your experience with developing IEPs for these students? b. To what extent do you feel that IEPs adequately meet the needs of these students? 304 12. Does this school have any official policies and procedures for supporting/responding to students with identified mental health needs? If so, what are they? a. Do you think the policies and procedures of the school help teachers respond adequately to students who have identified mental health needs? (Barbara Aved Associates, 2014) b. Why or why not? c. Do you think this school does a good job of supporting students with mental health difficulties? Why or why not? d. Do you think the school provides sufficient and adequate resources to support students with identified mental health concerns? Why or why not? 13. What changes, if any, would you suggest or recommend to improve the ways in which students with mental health difficulties are supported at this school? 14. Is there anything else you would like me to know about your experience and the support you provide at school? 305 General Education Teachers 1. Tell me about your role as a teacher at your school (e.g., what do you teach?) 2. To what extent do you believe addressing students’ mental health needs is part of your role? 3. What do you perceive to be the biggest mental health concerns among students at this school? a. What do you think contributes to these mental health concerns? What are some major stressors? b. What do you perceive students’ needs to be at school? 4. What are the most important or biggest barriers for students to access mental health services? 5. What do you think the role of the school is in supporting student mental health? 6. What does this school do to support the mental health of all students? a. Do you think the support provided is adequate to meet the needs of students? b. How has this support been impacted by COVID-19? 7. What supports are specifically in place for students with R/H designations? What does this school do to support the mental health of students identified as having mental health concerns (i.e., a designation in the R or H category)? a. Who is involved in providing these supports? b. Where do students go to receive support? c. If a student is in need of support, what do they do to find or obtain support? 8. How do you think being identified as a student with mental health concerns supports students? 306 a. Does a designation adequately support students? 9. How do you support students who are identified as having mental health concerns? a. Do you feel confident or qualified to support these students? i. Why or why not? ii. What would you need to feel more confident or qualified? b. What hinders your ability to provide this support? c. What helps your ability to provide this support? 10. As the number of students with mental health difficulties has been increasing in schools, have your teaching practices changed in response to this increase? a. If so, how? 11. I would like to talk specifically about IEPs for students with identified mental health concerns. a. What is your involvement or role in students’ IEPs? b. How do you go about implementing an IEP? What helps or hinders this process? c. To what extent do you feel that IEPs adequately meet the needs of these students? d. What changes, if any, would you make to IEPs (meetings and/or document)? 12. Does this school have any official policies and procedures for supporting/responding to students with identified mental health needs? If so, what are they? a. Do you think the policies and procedures of the school help teachers respond adequately to students who have identified mental health needs? (Barbara Aved Associates, 2014) i. Why or why not? 307 b. Do you think this school does a good job of supporting student mental health in general, as well as students with identified mental health difficulties? Why or why not? c. Do you think the school provides sufficient and adequate resources to support student mental health and specifically to support students with identified mental health concerns? Why or why not? 13. What changes, if any, would you suggest or recommend to improve the ways in which student mental health is supported at this school, as well as specifically students with mental health difficulties are supported at this school? 14. Is there anything else you would like me to know about your experience and the support you provide at school? 308 Educational Assistants 1. Tell me about your role as a special education teacher at your school. a. What are your responsibilities? b. How do you feel about these responsibilities? c. Are there any changes that you would make to these responsibilities? E.g., things you think you should be doing or things you do not think are your responsibility 2. To what extent do you believe addressing students’ mental health needs is part of your role? 3. What do you perceive to be the biggest mental health concerns among students at this school? a. What do you think contributes to these mental health concerns? What are some major stressors? b. What do you perceive students’ needs to be at school? 4. What do you think the role of the school is in supporting student mental health? 5. What does this school do to support the mental health of all students? a. What does this school do to support students with R/H designations? b. How has this support been impacted by COVID-19? 6. How do you think the overall school climate is supportive of student mental health? a. What is your perception of stigma towards mental illness at the school? Among adults and/or students? 7. Thinking about the students you work with/at this school, what are the most important or biggest barriers for students to access mental health services? 8. Tell me about the process for a student to receive an R or H designation. 309 a. What is your involvement in this process? b. What changes, if any, would you make to this process? 9. How do you think being identified as a student with mental health concerns supports students? a. Do you think a designation adequately supports students? 10. What supports are specifically in place for these students? What does this school do to support the mental health of students identified as having mental health concerns (i.e., a designation in the R or H category)? a. Who is involved in providing these supports? b. Where do students go to receive support? c. If a student is in need of support, what do they do to find or obtain support? 11. How do you support students who are identified as having mental health concerns? a. Do you feel confident or qualified to support these students? i. Why or why not? ii. What would you need to feel more confident or qualified? b. What hinders your ability to provide this support? c. What helps your ability to provide this support? 12. As the number of students with mental health difficulties has been increasing in schools, have your teaching practices changed in response to this increase? a. If so, how? 13. I would like to talk specifically about IEPs for students with identified mental health concerns. a. What is your involvement or role in students’ IEPs? 310 b. How do you go about implementing an IEP? What helps or hinders this process? c. To what extent do you feel that IEPs adequately meet the needs of these students? d. What changes, if any, would you make to IEPs (meetings and/or document)? 14. Does this school have any official policies and procedures for supporting/responding to students with identified mental health needs? If so, what are they? a. Do you think the policies and procedures of the school help teachers respond adequately to students who have identified mental health needs? (Barbara Aved Associates, 2014) b. Why or why not? c. Do you think this school does a good job of supporting students with mental health difficulties? Why or why not? d. Do you think the school provides sufficient and adequate resources to support students with identified mental health concerns? Why or why not? 15. What changes, if any, would you suggest or recommend to improve the ways in which students with mental health difficulties are supported at this school? 16. Is there anything else you would like me to know about your experience and the support you provide at school? 311 School Mental Health Professional 1. Tell me about your role as a counsellor/school psychologist at your school. a. What are your responsibilities? b. How do you feel about these responsibilities? c. Are there any changes that you would make to these responsibilities? E.g., things you think you should be doing or things you do not think are your responsibility 2. What do you think is the role of school counselors or school psychologists in protecting the mental health of students? /To what extent do you believe addressing students’ mental health needs is part of your role? (Beames et al., 2020) 3. What do you perceive to be the biggest mental health concerns among students at this school? a. What do you think contributes to these mental health concerns? What are some major stressors? b. What do you perceive students’ needs to be at school? 4. What do you think is the role of the school in supporting student mental health? (Beames et al., 2020) 5. What does this school do to support the mental health of all students? a. How has this support been impacted by COVID-19? 6. Thinking about the students you work with/at this school, what are the most important or biggest barriers for students to access mental health services? 7. Are you involved in the process of students receiving an R or H designation? a. If so, how are you involved? b. What does it mean to you when a student has an R or H designation? 312 c. What changes, if any, would you make to this process? 8. How do you think being identified as a student with mental health concerns supports students? 9. What supports are specifically in place for students with R/H designations? / What does this school do to support the mental health of students identified as having mental health concerns (i.e., a designation in the R or H category)? a. Who is involved in providing these supports? b. Where do students go to receive support? c. If a student is in need of support, what do they do to find or obtain support? 10. How do you support students who are identified as having mental health concerns? a. Do you feel confident or qualified to support these students? i. Why or why not? ii. What would you need to feel more confident or qualified? b. What hinders your ability to provide this support? c. What helps your ability to provide this support? 11. Are you involved in developing IEPs for students with an R or H designation? a. If so, how? b. Tell me about your experience with developing IEPs for these students. c. Do you attend IEP meetings? i. If so, what is your role in the meeting? ii. Tell me about your experience at IEP meetings. iii. Who else typically attends? d. To what extent do you feel that IEPs adequately meet the needs of these students? 313 e. What changes, if any, would you make to IEPs (the document and/or meetings)? 12. Does this school have any official policies and procedures for supporting/responding to students with identified mental health needs? If so, what are they? a. Do you think the policies and procedures of the school help school personnel, including yourself respond adequately to students who have identified mental health needs? (Barbara Aved Associates, 2014) i. Why or why not? b. Do you think this school does a good job of supporting students with mental health difficulties? Why or why not? c. Do you think the school provides sufficient and adequate resources to support students with identified mental health concerns? 13. What changes, if any, would you suggest or recommend to improve the ways in which students with mental health difficulties are supported at this school? 14. Is there anything else you would like me to know about your experience and the support you provide at school? 314 Community Mental Health Professional 1. Tell me about your role as a mental health professional at your community agency. a. What are your responsibilities? b. To what extent does your role as community mental health professional involve collaborating with this school/students’ schools in general? 2. What is your relationship to this school? a. In which ways do you provide support to students at this school? 3. What do you perceive to be the biggest mental health concerns among students at this school? a. What do you think contributes to these mental health concerns? What are some major stressors? b. In thinking about the students you work with who attend this school, what do you perceive students’ needs to be at school? 4. What do you think is the role of the school in supporting student mental health? (Beames et al., 2020) 5. To your knowledge, what does this school do to support the mental health of all students? a. What does this school do to support students with identified mental health concerns? b. How has this support been impacted by COVID-19? 6. Thinking about the students you work with who attend this school, what are the most important or biggest barriers for students to access mental health services at the school? 7. How do you think being identified as a student with mental health concerns supports students? 315 8. What supports are specifically in place for students with R/H designations? / What does this school do, to your knowledge, to support the mental health of students identified as having mental health concerns (i.e., a designation in the R or H category)? a. Who is involved in providing these supports? b. Where do students go to receive support? c. If a student is in need of support, what do they do to find or obtain support? 9. How do you support students who are identified as having mental health concerns? 10. Are you involved in developing IEPs for students with an R or H designation? a. If so, how? b. Tell me about your experience with developing IEPs for these students. c. Do you attend IEP meetings? i. If so, what is your role in the meeting? ii. Tell me about your experience at IEP meetings. iii. Who else typically attends? d. To what extent do you feel that IEPs adequately meet the needs of these students? e. What changes, if any, would you make to IEPs (the document and/or meetings)? 11. To your knowledge, does this school have any official policies and procedures for supporting/responding to students with identified mental health needs? If so, what are they? a. Do you think the policies and procedures of the school help school personnel, including yourself respond adequately to students who have identified mental health needs? (Barbara Aved Associates, 2014) i. Why or why not? 316 b. Do you think this school does a good job of supporting students with mental health difficulties? Why or why not? c. Do you think the school provides sufficient and adequate resources to support students with identified mental health concerns? 12. What changes, if any, would you suggest or recommend to improve the ways in which students with mental health difficulties are supported at this school? 13. Is there anything else you would like me to know about your experience and the support you provide at school? 317 School Administrators 1. Tell me about your school. 2. Tell me about your role as the principal/vice-principal at your school. a. What are your responsibilities? b. To what extent do you interact directly with students and families? 3. What do you think is the role of school administrators in protecting the mental health of students? /To what extent do you believe addressing students’ mental health needs is part of your role? (Beames et al., 2020) 4. What do you perceive to be the biggest mental health concerns among students at this school? a. What do you think contributes to these mental health concerns? What are some major stressors? b. What do you perceive students’ biggest needs to be at school? 5. What do you think is the role of the school is in supporting student mental health? (Beames et al., 2020) 6. Do you feel that student mental health is a priority at your school? Why or why not? 7. Do you think the overall climate of the school is supportive of students’ mental health? a. Why or why not? b. What changes, if any, would you make to the school’s mental health climate? 8. How important do you think it is for students to feel connected to school? a. How does this school/school personnel foster school connectedness among its students? 318 b. To what extent do you think the school adequately fosters school connectedness among its students? 9. Describe how mental health is discussed at school. a. In the class setting? Do you formally learn about mental health in class as part of the curriculum? b. Informally among students? 10. Thinking about the students at this school, what are the most important or biggest barriers for students to access mental health services? 11. Are you involved in the process of students receiving an R or H designation? a. If so, how are you involved? b. What changes, if any, would you make to this process? 12. How do you think being identified as a student with mental health concerns supports students? 13. What does this school do to support the mental health of all students? 14. What supports are specifically in place for students with R/H designations? / What does this school do to support the mental health of students identified as having mental health concerns (i.e., a designation in the R or H category)? a. What do you know about these services? b. Who provides these services? c. Where do students go to receive support? d. If a student is in need of support, what do they do to find or obtain support? e. Does your school have any initiatives or programs that target student mental health? If so, what are they? 319 f. Do you think the available supports adequately meet the needs of students? 15. How do you support students, both directly and indirectly, who are identified as having mental health concerns? a. Do you feel confident or qualified to support these students? i. Why or why not? ii. What would you need to feel more confident or qualified? b. What hinders your ability to provide this support? c. What helps your ability to provide this support? 16. Are you involved in developing IEPs for students with an R or H designation? a. If so, how? b. Tell me about your experience with developing IEPs for these students. c. Do you attend IEP meetings? i. If so, what is your role in the meeting? ii. Tell me about your experience at IEP meetings. iii. Who else typically attends? d. To what extent do you feel that IEPs adequately meet the needs of these students? e. What changes, if any, would you make to IEPs (the document and/or meetings)? 17. Does this school have any official policies and procedures for supporting/responding to students with identified mental health needs? If so, what are they? a. Do you think the policies and procedures of the school help school personnel, including yourself respond adequately to students who have identified mental health needs? (Barbara Aved Associates, 2014) b. Why or why not? 320 c. Do you think this school does a good job of supporting students with mental health difficulties? Why or why not? d. Do you think the school provides sufficient and adequate resources to support students with identified mental health concerns? 18. What changes, if any, would you suggest or recommend to improve the ways in which students with mental health difficulties are supported at this school? 19. Is there anything else you would like me to know about your experience and the support you provide at school? 321 Appendix H: Mental Health Resource Lists Mental Health Resources for Youth Kelty Mental Health Resource Centre The Kelty Mental Health Resource Centre helps families across BC navigate the mental health system, connect with peer support, and access resources and tools to support wellbeing. Local Phone: 604-875-2084 Toll Free: 1-800-665-1822 Email: keltycentre@cw.bc.ca Visit http://keltymentalhealth.ca/ for mental health resources Children and Youth Mental Health (CYMH) Services CYMH offers free and voluntary community-based mental health supports and services for children and youth between the ages of 0-18 years. Visit http://www.vch.ca/your-care/mental-health-substance-use/children-youth-mental-health-services for a list of youth mental health services. North Shore Youth Mental Health & Addiction Services – VCH The North Shore Youth Mental Health & Addiction Services consists of a multidisciplinary team that can support youth between the ages of 13-18 years with a range of challenges including substance use, anxiety, depression, behavioural issues, ADHD, and other mental health issues. 604-984-3795 Monday-Friday: 8:30am-4:30pm Foundry Offers young people ages 12-24 health and wellness resources, services and supports - online and through integrated service centres in communities across BC. Visit https://foundrybc.ca/ to find a Foundry Centre near you North Shore Foundry BC: 604-984-5060 https://foundrybc.ca/northshore/ Drop In Counselling Hours Monday & Thursday 1:00 pm – 6:00 pm Tuesday/ Wednesday 1:00 pm – 5:00 pm In Crisis Greater Vancouver: 604-872-3311 Toll Free: 1-866-661-3311 1-800-SUICIDE: 1-800-784-2433 Crisis Chat: http://crisiscentrechat.ca/ https://crisiscentre.bc.ca/get-help/ Kids Help Phone 322 1-800-668-6868 https://kidshelpphone.ca/ Youth in BC Chat http://youthinbc.com/ BC Mental Health Support Line 310-6789 (do not add area code) Free and available 24 hours a day. Child and Adolescent Response Team (CART) CART provides urgent, community-based response to mental health related crisis involving school-aged children and youth (up to 18) living in Vancouver who are experiencing urgent psychiatric or emotional crisis. 604-874-2300 401-1212 West Broadway, Vancouver, BC Youth Urgent Response Team (YURT) YURT is a multi-disciplinary and evidence-informed approach to support 13-19 year old youth who are in need of more urgent or intensive mental health and/or substance use services. Urgent: 604-984-3884 Non-urgent: 604-988-3131 ext. 5406 Schedule: • Tuesday to Friday 9:00 am - 10:00pm • Saturday to Monday 11:30am - 10:00pm Visit these websites for more information and resources about mental health and where to find help. Here to Help: http://www.heretohelp.bc.ca/ BC Mental Health & Substance Use Services: http://www.bcmhsus.ca/ Mental Health and Substance Use Supports in BC: https://www2.gov.bc.ca/gov/content/mental-health-support-in-bc/children-and-youth Health Link BC: https://www.healthlinkbc.ca/mental-health Mind Health BC: http://www.mindhealthbc.ca/ Anxiety Canada: https://www.anxietycanada.com/ 323 Mental Health Resources for Parents The Kelty Dennehy Mental Health Resource Centre (KDMHRC) The KDMHRC is a place where people affected by mental health challenges, and their family and friends can go to seek support and get trusted information. It offers peer navigation, social support groups and programs, and a resource library. Located at 1337 St. Andrews Avenue, North Vancouver, BC, on the ground floor of the HOpe Centre at Lions Gate Hospital, next to the HOpe Café. Visit https://northwestvancouver.cmha.bc.ca/programs-services/kdmhrc/ 604-984-5000 ext. 5190 keltyhope@cmha.bc.ca North Shore Community Mental Health and Addiction Services Provided by Vancouver Coastal Health, these services include adult assessment and treatment services, community psychiatric services, rapid access psychiatric services, and others. Located at the HOpe Centre, 1337 St. Andrew’s Ave, North Vancouver, BC 604-984-5000 Health Connections Clinic Health Connections Clinic is an easy-to-access primary care for North Shore residents without a family doctor who have complex medical, mental health and/or substance use challenges. No referral necessary. 148 East 15th Street, North Vancouver, BC 604-984-3777 In Crisis Greater Vancouver: 604-872-3311 Toll Free: 1-866-661-3311 1-800-SUICIDE: 1-800-784-2433 Crisis Chat: http://crisiscentrechat.ca/ https://crisiscentre.bc.ca/get-help/ BC Mental Health Support Line 310-6789 (do not add area code) Free and available 24 hours a day. Visit these websites for more information and resources about mental health and where to find help. Here to Help: http://www.heretohelp.bc.ca/ BC Mental Health & Substance Use Services: http://www.bcmhsus.ca/ Mental Health and Substance Use Supports in BC: https://www2.gov.bc.ca/gov/content/mental-health-support-in-bc/children-and-youth Health Link BC: https://www.healthlinkbc.ca/mental-health Mind Health BC: http://www.mindhealthbc.ca/ Anxiety Canada: https://www.anxietycanada.com/
Thesis/Dissertation
eng
School and Applied Child Psychology
Vancouver : University of British Columbia Library
Attribution-NonCommercial-NoDerivatives 4.0 International
Graduate
Ford, Laurie
School-based support for students experiencing mental health challenges : a case study
Text