Acceptability of a Multi-Tiered, Identity-Affirming School Mental Health Strategy: An Audit of Ontario School District Action Plans

Child and adolescent mental health needs have increased over recent decades. Schools play a vital role in addressing these needs through multi-tiered systems of support, including universal mental health promotion (Tier 1), targeted and intensive services (Tiers 2 and 3). School Mental Health Ontario (SMH-ON) is a provincial implementation support partner to the Ministry of Education focused on enhancing quality, scalability and sustainability of multi-tiered mental health support for Ontario’s 72 school districts. This implementation study examined the acceptability of the SMH-ON strategy through an audit of district action plans ( n = 61; 84.7%) for nine key strategic elements. On average, districts referred to 7.25 out of the nine key elements. The most prevalent elements were Tier 1 Mental Health Literacy (96.7%) and Tier 1 Parent, Caregiver & Community Connections (93.4%) , indicated in more than 9 of 10 plans. The least prevalent were Tier 2 Early Identification & Student Support (60.7%) and Student Leadership and Agency (70.5%). Potential synergies of implementation activity were observed, providing guidance for implementation planning. Findings underscore the value of provincial leadership in promoting the acceptability of school-based mental health initiatives and highlight priority areas requiring further attention to support comprehensive and sustained implementation.