Middle School Mental Health Toolkit
Middle School Mental Health Toolkit
HEALTH
                                 TOOLKIT
                            OF MIDDLE SCHOOL STUDENTS
Created by: Joshua Le, Taryn Hastie, Vickie Joo, Abbey Umali, and Hannah Miller
         HEY CAREGIVERS!
        Welcome to the wonderful stage of middle school!
   We believe every child can find joy and success while meeting the
   challenges of this age. This toolkit is meant to help you understand
common mental health concerns that pop up in middle school and how to
 identify when to seek additional help. We will include many tools for all
     caregivers to support students in processing the difficulties of
                              adolescence.
              TABLE OF CONTENTS
  SECTION 1     Key Terms, Statistics, Common Concerns, Protective Factors
SECTION 3 Interventions & Tools, Tips for Talking About Mental Health
                                                    KEY TERMS
                                                       for Caregivers to Know
        Mental Health
        Mental health is like physical health for the brain and emotions, in other words, the
        level of being capable of coping with everyday stressors, working productively, and
        making positive contributions to one's community.
                                                          [1]
        *Everyone has a different level of mental health
                                                                                                                [2]
                                         There are 5 areas that make up mental wellness:
      Mental                                 positive emotions       meaning in life
                                                                     accomplishments
      Wellness                               engagement
                                             relationships
        Coping Skills
          Ways of working through stressful or challenging situations, including healthy or
                               [5]
          unhealthy strategies
 1. World Health Organization. (n.d.). Mental health: Strengthening our response. World Health Organization. Retrieved September 25,
    2022, from https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response
2. Seligman, M. (2018). PERMA and the building blocks of well-being. The Journal of Positive Psychology, 13(4), 333–335.
    https://doi.org/10.1080/17439760.2018.1437466
3. Doll, B., Nastasi, B. K., Cornell, L., & Song, S. Y. (2017). School-Based Mental Health Services: Definitions and Models of Effective
    Practice. Journal of Applied School Psychology, 33(3), 179–194. https://doi.org/10.1080/15377903.2017.1317143
4. Fundamentals of sel. CASEL. (2022, March 11). Retrieved September 25, 2022, from https://casel.org/fundamentals-of-sel/
5. American Psychological Association. (n.d.). Apa Dictionary of Psychology. American Psychological Association. Retrieved October 2,
    2022, from https://dictionary.apa.org/coping-strategy
          FACT SHEET
                   for Caregivers
Suicide is PREVENTABLE
              SUICIDE/CRISIS HOTLINES:
                    Call or text 988
                                                       Centers for Disease Control and
                 Text HELLO to 741741                  Prevention. (2022, September 12).
                                                       Mental health. Centers for Disease
                                                                                                                                                                                       Involvement
                           Mental Health                                                                                    1
                                                                                                                                                                  Parental involvement (parent-teacher
                                                                                                                                                                  communication, attendance at school
                          how common is it in the world?
                                                                                                                                                                  events, structuring homework time,
                 Anxiety:                                                                                        6.5%                                             and monitoring school work) was
                                                                                                                                                                  found to improve:      3
ADHD: 3.4%
1. Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3):345-65. doi: 10.1111/jcpp.12381. Epub 2015 Feb 3. PMID:
   25649325
2. Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Social Science & Medicine, 90, 24-31. doi: 10.1016/j.socscimed.2013.04.026. Epub 2013 May 4. PMID: 23746605.
3. Wang, M. T. & Sheikh-Khalil, S. (2014). Does parental involvement matter for student achievement and mental health in high school? Child Development, 85(2), 610-625.
4. Stoep, A. V., Weiss, N. S., Kuo, E. S., Cheney, D., & Cohen, P. (2003). What proportion of failure to complete secondary school in the US population is attributable to adolescent psychiatric disorder? Journal of Behavioral Health Services & Research, 30, 119–124. doi:10.1007/BF02287817
5. Gutman, L. M., Sameroff, A. S., & Eccles, J. S. (2002). The academic achievement of African American students during early adolescence: An examination of risk, promotive, and protective factors. American Journal of Community Psychology, 30, 367–399. doi:10.1023/ A:1015389103911
         COMMON CONCERNS
Remember! Just
because your student
                                                for Middle School Aged Students
is feeling these things
doesn't mean they have
a mental illness.                                                                 Disordered Eating
Ask a social worker or
                                                                                  All students may have changes in
school psychologist for
help!                                                                             appetite, weight, and body
                                                                                  image. A student's relationship
                 Depression                                                       with food becomes a concern
       All students may experience bouts
                                                                                  when feelings and habits
       of sadness, especially after
                                                                                  regarding weight and eating
       changes in friendships or a
                                                                                  become extreme. [3]
       disappointing grade at school.
       Feeling irritable is also typical in
       response to frustration with a                                                             Bullying
       friend or project. Sadness                                                 All students may have issues with
       becomes a concern when it                                                  peers. Bullying becomes a
       becomes persistent & interferes                                            concern when a student has
       with daily activities.[1]                                                  repeated unwanted aggressive
                                                                                  behaviors directed at them,
                                                                                                                       [4]
                         Anxiety                                                  physically, emotionally, or socially.
       All students may feel worried or
       fearful in situations where it                                               Social Media Use
       makes sense to feel that way.                                              All students who use social media
       Anxiety becomes a concern when                                             might be exposed to negative
       those feelings carry on past                                               content. Caregivers should limit
       situations where they make sense                                           and monitor social media use
       and worsen, interfering with                                               when it may cause bullying, and
                                 [2]
       school and relationships.                                                  symptoms of depression/anxiety.
1. U.S. Department of Health & Human Services. (2022, March 1). Depression. https://www.mentalhealth.gov/what-to-look-for/mood-disorders/depression
2. U.S. Department of Health & Human Services. (2022, March 11). Anxiety disorders. https://www.mentalhealth.gov/what-to-look-for/anxiety-disorders
3. U.S. Department of Health & Human Services. (2022, March 11). Eating disorders. https://www.mentalhealth.gov/what-to-look-for/eating-disorders
4. Centers for Disease Control and Prevention. (2021, September 2). Fast fact: Preventing bullying |violence prevention|injury Center|CDC. Centers for
   Disease Control and Prevention. Retrieved October 3, 2022, from https://www.cdc.gov/violenceprevention/youthviolence/bullyingresearch/fastfact.html
             SIGNS TO LOOK FOR
                     Common Concerns Your Child May Have
                                                                       [1]                                                                                            [2]
                       Depression                                                             Disordered Eating
                      Loss of interest in                                                             Overly focused on food,
                      typically preferred                                                             counting calories, carbs,
                                                                                                      protein, and fat
                      activities (although as
                                                                                                      Avoidance of eating in front of
                      adolescents grow there
                                                                                                      others
                      interests change, so if                                                         Extreme concern about body
                      one interest changes to a                                                       shape and size
                      new interest this is                                                            Frequent checking mirror for
                      normal)                                                                         flaws
                      Changes in appetite                                                             Obsession with physical
                                                                                                      activity
                      Feeling “down in the
                                                                                                      Following fad diets or
                      dumps” for prolonged
                                                                                                      eliminating an entire food
                      periods of time                                                                 group
                                                                               [3]
                                              Anxiety
                   Excessive fear/worry
                   Tendency to be hypervigilant (aware of surroundings,
                   cautious of other people)
                   Express feelings of worry and nervousness even
                   without the presence of a threat
                   Avoidance of usual activities
                   Fear of trying new things
1. American Psychology Association. (2017). In Diagnostic and statistical manual of mental disorders: DSM-5 (pp. 160–164), CBS Publishers & Distributors, Pvt. Ltd.
2. NEDA. (2021, July 14). Warning signs and symptoms. National Eating Disorders Association. Retrieved November 10, 2022, from
   https://www.nationaleatingdisorders.org/warning-signs-and-symptoms
3. AACP. (n.d.). Your adolescent - anxiety and avoidant disorders. American Academy of Child and Adolescent Psychology. Retrieved November 10, 2022, from
   https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Anxiety_Disorder_Resource_Center/Your_Adolescent_Anxiety_and_Avoidant_Disorders.aspx
PROTECTIVE FACTORS
       for Middle School Aged Students
  Social Skills
                       These skills include:[2]
                           The ability to express how one is feeling
Good social skills and and/or what their needs are
   peer relations          Impulse control (like respecting other’s
                           boundaries and not lashing out when
 contribute to better
                           upset)
   well-being and          Manage negative thoughts and
                   [1]
   mental health           emotions (this does not mean always
                           being positive, but being able to
                           address negative thoughts and feelings
                           in a healthy/constructive way)
                                Coping Skills
                  There are different types of coping strategies
                  that can be used based on the source of the
                                                            [3]
                  problem/stress. These strategies include:
                      Social-focused
                      Emotion-focused
                      Problem-focused
                      Meaning-focused
Social-Focused                                                   Problem-Focused
Getting support from friends,                                        Best for when a person has the capability to
                                                                     change the situation. It includes planning,
family, or other trusted adults                                      using a to-do list, time management,
                                                                     problem-solving,
Ex. A student is upset about a fight they had
with their sibling, so they call a friend to talk                    Ex. A student has a big test coming up, to
about it.                                                            reduce test anxiety they can plan on
                                                                     spending 30 minutes a day studying over a
                                                                     two-week period to feel prepared.
Emotion-Focused
Best for when a person does not have the
capability to change the situation. This                         Meaning-Focused
includes reframing the situation, accepting                       Similar to emotions focused, this type of
the situation, using humor, and seeking                           strategy looks to find purpose in any
support from one’s faith/spirituality.                            challenge.
Ex. A student has a teacher who is ‘too rigid’                    Ex. A student’s best friend starts dating their
in their point-of-view, but a class change isn’t                  crush. They can see it as a way of learning
possible. They can reframe their perspective                      how to deal with disappointment which will
as a learning opportunity and a challenge                         serve them all throughout their life (while the
that will lead to positive growth                                 potential relationship may have been short
                                                                  lived or toxic anyways).
        SCHOOL PROFESSIONALS
                                                         and their roles
                                                                                             Social Worker
            School Counselor                                                             School social workers help
                                                                                      students, families, and teachers
           School counselors help students
                                                                                          address problems such as
          form healthy goals, mindsets, and
                                                                                         truancy, social withdrawal,
            behaviors. Counselors provide
                                                                                       overaggressive behaviors, and
             direct mental health support
                                                                                     emotional or economic problems.
            through individual and group
           counseling, referrals to outside
                                                                                      Their role is to support students
            resources, and crisis support.                                              overall well-being, connect
          They also provide indirect support                                         students to community resources,
           through universal mental health                                               and provide crisis support.
                     curriculum.
                                                                                  These are the potential roles and activities these professionals
                                                                                           can engage in and may vary across schools
Graham, A., Phelps, R., Maddison, C., & Fitzgerald, R. (2011). Supporting children’s mental health in schools: teacher views.
        UNIVERSAL SCREENINGS
           & ASSESSMENTS
          What Are Universal                                                         Will I Be Asked to Give
            Screenings?                                                                      Consent?
         Universal screenings are                                             Schools aren't required to get parent
      questionnaires and surveys that                                           or guardian consent for universal
    schools use to gather data on the                                        screenings that gather information for
  needs of their students. Data collected                                      instruction or regular school-wide
    from screenings drive school-wide                                        activities, but you can opt out. Parents
  programs and classroom lesson topics.                                      & guardians will be asked for consent
   They also help identify students who                                       for screenings for mental health and
                                                                                                               [1, 3]
  could benefit from extra mental health                                           individualized assessments.
                  support. [1]
                                                                                   How Will I Be Involved?
      What Are Assessments?                                                  Have your child participate in universal
   Assessments are a way of gathering                                         screenings to give the best picture of
  data for individual student needs. They                                      student needs and help their school
     help determine whether a student                                           plan for programs and resources to
     would benefit from individualized                                           support your student. Your child's
    services and if so, help create plans                                     school may also use parent screening
  for carrying out those services. Once a                                    tools, which are another great way for
       student has services in place,                                            you to share information for your
    assessments also help the student's                                         student to access any support they
        team monitor their progress.[2]                                      may need. If your child is identified to
                                                                               receive an assessment, your consent
                                                                                  will help them access additional
                                                                                              resources.[1, 3]
 You can always ask your child's   1. Donohue, P. (2019). Universal screening to support MTSS. In Goodman-Scott, E., Betters-Bubon, J., Donohue, P. (Eds.),
school counselor or psychologist   The school counselor’s guide to multi-tiered systems of support (pp. 341-395). Routledge.
                                   2. National Association of School Psychologists (2009). School psychologists’ involvement in assessment (Position
      about screenings &           Statement). Retrieved from https://www.nasponline.org/research-and-policy/policy-priorities/position-statements
                                   3. Doll, B., Dart, E.H., Arora, P.G., Collins, T.A. (2021). Framing school mental health services within a dual-factor model of
         assessments!              mental health. In Lazarus, P.J., Suldo, S.M., Doll, B. (Eds.), Fostering the emotional well-being of our youth (pp. 40-60.
                                   Oxford.
                COMMONLY USED
                SCREENING TOOLS
   Screening Tool                   Description                Ages       Administration Time
                      1st:
                      2nd:
                      3rd:
                                     Class Performance and
 Period Teacher       4th:
                                             Grades
                      5th:
                      6th:
                      7th:
                                        Curriculum and
    Principal
                                      Educational Concerns
English Language
                                         Interpretation
     Support
             MULTI-TIERED SYSTEMS
                                                             of Support
Goodman-Scott, E., Betters-Bubon, J., & Donohue, P. (2019). The school counselor's guide to multi-tiered systems of support. Routledge.
MULTI-TIERED SYSTEMS
                         at Home
COPING STRATEGIES
               to support mental health
   BASIC Ph Model
  Belief - rely on core values
  and spiritual communities
  Affect - freedom to express
  feelings and emotions
  Social - support from peer
  and family relationships
  Imagination - process
                                           Mindfulness
  creatively through play, art,
  stories, music, role-play, etc.           Activities
  Cognitive - direct approaches     To bring awareness to body/mind
                                        and increase self-kindness
  and strategies for problem-
                                    Body scan
  solving
                                       Notice the
  Physiological - formal and
                                       sensations/tensions in every
  informal opportunities for
                                       part of your body and
  physical activity such as            acknowledge your thoughts
  sports, games, exercise, etc.        about them
                                    Meditation
                                       Spend a few minutes in a
                                       quiet area with limited
                                       distractions focusing on your
                                       breathing and being aware of
                                       any thoughts or emotions that
                                       arise
                                       Can be done sitting, walking,
                                       lying down, etc.
COPING STRATEGIES
                to support mental health
                                            Breathing
                                            Techniques
                                     To regulate heart rate, decrease
                                        tension, and lessen anxiety
                                        Box breathing
                                            Breath in for 4 seconds,
                                            hold for 4 seconds,
 Grounding Exercises                        breathe out for 4 seconds,
To help bring focus to the present          hold for 4 seconds, repeat
  when feeling intense emotions         4-7-8 breathing
5-4-3-2-1 (sensory awareness)               Breathe in for 4 seconds,
    Notice 5 things you can see, 4          hold for 7 seconds,
    things you can touch, 3 things          breathe out audibly for 8
    you can hear, 2 things you              seconds, repeat
    can smell, and 1 thing you can
    taste
Distraction
    Count backward from 100 in
    7s
    List as many items in a
    category as you can (animals,
    countries, fruits, etc.)
                                                 STRENGTHS LIST
     In this activity, you will learn about personal strengths and the strengths of others. Begin by asking direct questions to identify
      your strengths (What are you good at? What do you enjoy doing?). Be sure to identify the trait associated instead of the skill
                                              (basketball vs. athleticism; karate vs. disciplined).
       Once you have identified your strengths, ask yourself some questions that amplify your current strength (How else do you
        demonstrate that strength? What does that strength mean to you?). Consider other situations where you can use your
                                strengths and how you can use your strengths to achieve other goals
1. Park, N., & Peterson, C. (2009). Character strengths: Research and practice. Journal of College and Character, 10(4).
 AT-HOME ACTIVITIES
                                THREE GOOD PEOPLE
   This exercise asks clients to identify strengths in a fictional character, an inspiring person they know, and
themselves. Recognizing strengths in others primes students to begin thinking about their own strengths. Filling
        out this exercise can support your child’s mood, self-esteem, and ability to achieve their goals.
1. Carr, A., & Finnegan, L. (2015). The say ‘yes’ to life (SYTL) program: A positive psychology group intervention for
  depression. Journal of Contemporary Psychotherapy, 45(2), 109-118.
      AT-HOME ACTIVITIES
                          EMOTION EXPLORATION SCALE
      This exercise can be used to guide your child through their emotions and how it translates into their
     behavior. By exploring their emotion at different levels, caregivers can demonstrate how emotions can
                                     progress from low levels to high levels.
                                    Emotion:
      1          2          3           4           5          6          7          8           9         10
1. Kunnanatt, J. T. (2004). Emotional intelligence: The new science of interpersonal effectiveness. Human Resource
 Development Quarterly, 15(4), 489.
ACTIVIDADES EN CASA
    ESCALA DE EXPLORACIÓN DE LAS EMOCIONES
 Este ejercicio se puede utilizar para guiar a su hijo a través de sus emociones y cómo se traducen en
su comportamiento. Al explorar sus emociones en diferentes niveles, los cuidadores pueden demostrar
                 cómo las emociones pueden progresar de niveles bajos a niveles altos.
Emoción:
1         2         3          4          5          6         7          8         9         10
                    After                                                     , I will                                                          .
     practice
After , I will .
                                        Clear, J. (2018). Atomic habits: An easy & proven way to build good habits & break bad ones. Penguin.
    AT-HOME ACTIVITIES
               Supporting Positive Peer Relationships
      Middle school can be a challenging time for developing and maintaining relationships.
        Although it’s fairly common for students to lose or gain at least one friend in middle
      school, friendship instability can have a negative effect on a child’s mental health.[1]You
      can help your student build strong friendships by learning to look for and showing these
                                    qualities in a healthy friendship.
                                          1. Lessard, L. M., & Juvonen, J. (2018). Losing and gaining friends: Does friendship instability compromise
                                             academic functioning in middle school? Journal of School Psychology, 69, 143–153.
                                             https://doi.org/10.1016/j.jsp.2018.05.003
                                         2. Therapist Aid LLC. (n.d.). Relationship green flags (worksheet). Therapist Aid. Retrieved November 11,
                                             2022, from https://www.therapistaid.com/therapy-worksheet/relationship-green-flags
     AT-HOME ACTIVITIES
                                                             Gratitude Jar [1]
    Practicing gratitude has been shown to improve mental wellness. A family gratitude jar could be a fun
    way to make gratitude a daily practice!
    Here's what you'll need:
        Jar
        Paper
        Scissors
        Pen/pencils
        Any fun decorations you want to use to decorate the jar
                                  m e nt
         ra ti tu d e is a state
      Ag
                         iation or
          of apprec               e one
          n k fu ln e ss for som
      tha                    ing!
                or someth                                                                    Example:                                                        od a
                                                                                                                                                                 y
                                                                                                                                                        ht
                                                                                                                                              at   lunc
                                                                                                                                         er
                                                                                                                              g   s o cc
                                                                                                                         in
                                                                                                                    play
  Here's what you do:                                                                                       y   for
                                                                                                 h   ap p
     Either decorate a jar together as a family or let                                      I am
     each person decorate an individual jar
     After decorating, each person will add three
     gratitudes
     Create your own or use these prompts
         Today was special because…
         I appreciate (person), because
         Something I accomplished today…
         Something I’m looking forward to…
         Something I am thankful for…
         Something I like about my family…
         Three people who make me happy are…
         I felt happy today when…
         Something little that makes me smile…
         Today I had fun when…
     After everyone fills out their gratitude, talk
     together about what each person wrote down
     Put slips of paper into the jar for everyone to
     remember all the good things they're grateful
     for
1. Therapist Aid LLC. (n.d.). Gratitude jar activity (worksheet). Therapist Aid. Retrieved November 11, 2022, from https://www.therapistaid.com/therapy-
   worksheet/gratitude-jar
SECTION 4
COMMUNITY RESOURCES
  Scan the QR code to learn about these resources
               📍Located in Southern California
            FAMILIES TOGETHER OC
RECOMMENDED MEDIA
for further learning/continuing the conversation
                   Apps                                           Websites
 Check out these apps and how to use them to incorporate
  mindfulness, emotion regulation, focus/attention, and
     productivity into the lives of you and your child!
                                                             ABLE2LEARN.COM
                                                                                Social stories to
                                                                                guide your child
                                                                                 through their
                                                                              emotions, behaviors,
                                                                                and social skills
    MindYeti                 Headspace
                                                           MINDREMAKEPROJECT.ORG
                                                                                 Free worksheets,
                                                                                    guides, and
                                                                                information about
                                                                               developing a healthy
                                                                                   and growing
                 UCLA                                                         relationship with your
  TooNoisyPro                                                                     mental health
              Mindfulness
                                                Hotlines
                  Call 988 or 1-800-273-8255 | National Suicide Prevention Lifeline
                                      24/7 text/call/chat lifeline
                                 Suicide prevention and crisis support
                                Text HELLO to 741741 | Pelham Together
                                       24/7 text/website hotline
Support for stress and Anxiety, Depression, Self Harm, Suicide, Substance Abuse, LGBTQIA+, Abuse,
                                    BIPOC, Co-Occurring Disorders
                  Call or text 855-625-4657 | Orange County Health Care Agency
                                              24/7 call/text
                                  Crisis support for behavioral health
    Call or text 714-991-6412 | National Alliance on Mental Illness, Orange County (NAMI-OC)
                                              24/7 call/text
                                      Crisis and emotional support
                                                            FAQS
                                      Frequently Asked Questions
             What do I do if I'm worried                                                 Who should I call if I'm
              about my child's mental                                                  worried about my child's
                         health?                                                           immediate safety?
             Talk to your child                                                        If you think your child may hurt
             Reach out to your child's school                                          themselves or someone else
             counselor or school psychologist                                          and has the means to do so,
             Make an appointment with your                                             call 911
             child's pediatrician                                                      What will happen:
             Contact local community                                                   Communicate your concern
             agency for consultation                                                   for your child’s safety to the
             Call a crisis intervention hotline                                        911 operator. Communicate
                                                                                       their mental health diagnoses
            If I call a crisis hotline, what
                                                                                       and history (if they have
              would that conversation
                                                                                       them). When police arrive,
                       sound like?
                                                                                       state “this is a mental health
              If you’re worried your child may
                                                                                       crisis.” Some things that could
              be thinking about harming
                                                                                       happen: they could transport
              themselves or another person
                                                                                       your child to the hospital for a
              and there’s not an immediate
                                                                                       psychiatric evaluation if it’s
              risk of harm, call a crisis hotline
                                                                                       determined to be a need[2]
              You'll be connected to a
              trained crisis worker who will
                                                                                      What if I don't know what
              ask you a series of questions,
                                                                                                 to do?
              connect you to resources,
                                                                                      That's okay!
              develop a safety plan, and
                                                                                       Reach out to any of the
              contact police if immediate
                                                                                      resources above. Starting the
              safety concerns are present[1]
                                                                                      conversation is the hardest part
1. Mental Health America. (n.d.) What happens if I call the Suicide Prevention
Lifeline? https://screening.mhanational.org/content/what-happens-if-i-call-suicide-prevention-lifeline/
2. National Alliance on Mental Illness. (n.d.) Calling 911 and Talking with Police. https://www.nami.org/Your-Journey/Family-Members-and-Caregivers/Calling-
911-and-Talking-with-Police