But is She Happy? A Look at Screening in Multi-tiered Systems of Support

In recent years many school districts have adopted multi-tiered approaches, like Positive Behavioral Interventions & Supports frameworks, to address the mental health needs of children at school. Multi-tiered systems of support (MTSS) are generally organized into three increasingly intensive levels: primary, secondary, and tertiary. School teams regularly screen and monitor children’s behaviors and learning at school to determine which level of support would meet their needs. In most cases, this screening occurs about once every quarter.

Screening in schools is particularly important because schools, more than any other setting, have the potential to reach the largest number of children and youth. However, when many school districts engage in mental health screening, they are primarily seeking to identify children and youth who exhibit symptoms of mental illness.

There are huge differences between a teenager who is not depressed or anxious and one who bounds out of bed in the morning with twinkling eyes; between an adolescent who says no to drugs and one who says yes to meaningful involvement in family, school, and community activities; and between one who costs society little and one who actually benefits it. (Seligman et al., 2005, pg. 498)

We often view mental health as the absence of mental distress, but this isn’t enough. To fully ensure that we are meeting the mental health needs of children, a dual-factor model for screening must be adopted.

The dual-factor model takes into consideration both the absence of symptoms that signal mental distress and the presence of symptoms that signal mental health. Put simply, screening involves not just looking for signs of sadness, anger, or anxiety, but also for signs of happiness and contentment. Focusing on mental health is proactive and has the potential to serve as a foundation to support students before they experience greater difficulties.

Defining Mental Health

Defining mental health can be a bit difficult. Like so many other phenomenon, we seem to know it when we see it. But can we trust that a smiling child is happy? Keyes (2002) identified some more objective symptoms of mental health that include: (1) functioning well in most aspects of life, (2) participating in kind and trusting relationships, (3) growing into the best version of oneself, (4) having a purpose or direction in life, (5) adapting the environment to support one’s needs, and (6) having a sense of self-determination.

Others have defined mental health as the presence of subjective well-being. Subjective well-being is the scholarly term for, what is often known as, happiness and it has three discrete components: recurrent positive affect, absence of negative affect, and increased satisfaction with life.  When we define mental health through the construct of subjective well-being, we can measure it.

Screening for Subjective Well-being

What is the best way to know if students are happy? Ask them. The literature suggests that a person’s self-evaluation of subjective well-being provides important insights into how satisfied and competent one feels and how present protective factors (e.g., supportive relationships with friends) are on daily basis. High levels of self-reported subjective well-being have also been associated with lower levels of internalizing and externalizing behaviors (i.e., those we think might be related to prodromal symptoms) and increased levels of resilience.

While schools may opt to develop homegrown screening tools for subjective well-being, several valid and reliable screening tools are already available. Two examples of such tools are the Brief Multidimensional Students’ Life Satisfaction Scale  and the Multidimensional Students’ Life Satisfaction Scale. Both of these tools are based on the students’ self-report and geared at understanding how satisfied students are with life.

What’s Next?

So you’ve used a screening tool to look at subjective well-being and found that some of your students aren’t feeling as satisfied with life and their present circumstances as you would have expected. What now? In the next blog we’ll explore some examples of occupation-based groups and their influence on positive mental health and subjective well-being for children and youth.


About Dr. Susan Cahill

Dr. Susan Cahill is a former Associate Professor and Director of the MSOT Program at Lewis University. She is a Fellow of the American Occupational Therapy Association (AOTA) and a member of the AOTA Commission on Practice. Visit http://www.lewisu.edu/academics/msoccuptherapy to learn more.

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