Examined the ability of demographic variables and risk factors (parental substance use, number of people in the home, out-of-home placements, grades repeated, arrest history, and total life stress) to predict exposure to community violence among 342 high school students from inner-city Baltimore referred for mental health care in community centers or in the schools. Over 90% of the sample knew at least 1 victim of a violent act, 77% reported witnessing a violent act, and 47% reported past victimization by violence. Risk variables were more powerful regression predictors of violence exposure than demographic characteristics such as race, sex, or clinical setting. Even after controlling for demographic differences in violence exposure, risk factors as a group accounted for another 10% to 15% of variance. Life stress was the most consistent predictor of violence exposure for this sample, and life stress was the only variable to make a significant unique contribution to the prediction of all 4 violence criteria.

Collaboration between school- and community-employed professionals is critical to the success of SMH programs. Despite its promise, the success of SMH programs can be jeopardized by ineffective collaboration between school- and community-employed professionals. Strategies to overcome marginalization, promote authentic interdisciplinary teamwork, build effective coordination mechanisms, protect student and family confidentiality, and promote policy change and resource enhancements should be addressed in SMH improvement planning.

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When implemented with appropriate family, school, and community involvement, mental health screening in schools has the potential to be a cornerstone of a transformed mental health system. Screening, as part of a coordinated and comprehensive school mental health program, complements the mission of schools, identifies youth in need, links them to effective services, and contributes to positive educational outcomes valued by families, schools, and communities.

This study examined relationships between violence exposure, other stressors, family support, and self-concept on self-reported behavioral problems among 320 urban adolescents (aged 11-18) referred for mental health treatment. Overall, participants reported high levels of violence exposure, with a median of six past encounters with violence as a witness, victim, or through the experiences of associates. All forms of violence exposure (witnessing, being a victim, knowing of victims) were correlated with internalizing and externalizing behavioral problems for males and females. Total violence exposure predicted behavioral problems among participants, even after controlling for the effects of other risk, demographic and protective factors. Family support and self-concept moderated the influence of life stress and cumulative risk on problem behavior outcomes, but these protective variables did not significantly moderate violence exposure.

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As multitiered systems of support (MTSS) for improving student emotional/behavioral (EB) functioning are being scaled up nationally (Horner et al., 2014), there is a critical need to define how these approaches meet the needs of students presenting internalizing EB problems such as depression, anxiety, and trauma-related concerns. Contributing to the improvement of MTSS is the systematic joining of positive behavioral interventions and supports (PBIS) and school mental health (SMH) services. A recently defined interconnected systems framework (ISF; Barrett, Eber, & Weist, 2013) provides explicit guidance on doing this work, and a national workgroup for ISF is exploring its implementation in sites around the country. The theme of improving prevention and intervention for youth with internalizing issues is a significant emphasis in this effort. However, many schools and collaborating partners from the mental health and other youth-serving systems struggle to develop multitiered programs for youth with internalizing challenges. The underlying tenets and approaches for addressing internalizing problem behavior differ from those that focus on improving more distinct externalizing behaviors such as noncompliance, disruptiveness, rule violation, aggression, attention problems, and acting out. The overall goal of this article is to build from important prior reviews (e.g., McIntosh, Ty, & Miller, 2014) and lessons being learned as the ISF is implemented in sites across the country to improve multitiered promotion/prevention, early intervention, and intervention for students presenting internalizing problems. Within MTSS efforts, school staff and community collaborators (as in the ISF) continue to struggle to implement programs for youth with internalizing problems. Objectives of this article are to review background factors limiting attention to internalizing issues within MTSS and to present recommendations for moving the field forward in improving practice, research, and policy on these issues, with particular attention paid to the ISF and its critical role in this agenda. There are three sections to the article.

The challenge in most communities is to build a true system of care that involves proactive and more preventive care in natural settings, such as schools, and coordination and improvement of care for youth with more serious problems.