The ESMH Model

The WV ESMH Initiative exists so that every student in West Virginia can benefit from a school environment that supports social and emotional wellbeing to achieve his or her full potential.

Based on what works:

The ESMH framework requires the use of evidence, research-based and promising practices.

Leadership teams use data to identify student/school needs and select programs and services to address those needs.

Schools, families, and strategic community partners assume a shared responsibility to provide mental health support for ALL students. ESMH includes prevention; early intervention and treatment that are natural.

This initiative is driven by a state ESMH Steering Team that originated in 2007 as a partnership and shared commitment between the WV Department of Education, the WV DHHR Bureau for Behavioral Health and Health Facilities, and Marshall University School of Medicine. The team is now comprised of about 30 members representing over 20 entities statewide.

The Three Tiered Model

Tier 1: Universal Mental Health & Prevention

All Students: Prevention / Mental Health Promotion

Provided in the everyday learning environment in the classroom or large group settings.

85-90% of students will be successful when Tier 1 services are fully in place and aligned with best practice standards; without the need for Tier 2 & 3 services.


  • Social and emotional development
  • Drug and alcohol education
  • Suicide prevention
  • Student Transition Support
  • Peaceful conflict resolution
  • Parent involvement
  • Youth development programs
  • Use of data systems to identify needs and priorities and focus areas

Tier 2: Early Interventions

Students with identified academic, behavioral and emotional needs

Complementary to Tier 1: Successful Tier 2 services reduce the need for Tier 3 services.

5-15% of students need Tier 2 services when Tier I prevention programs are systemically implemented.



  • Short-term school counseling
  • Skill building counseling groups
  • Early identification, referral and monitoring of mood & risk behaviors
  • Learning and behavioral accommodations
  • Passive or active parent/guardian consent

Tier 3: Therapy & Intensive Support

Students with pervasive behavioral and/or mental health needs

Schools must ensure Tier1 & 2 services are provided to prevent students from moving into the Tier 3 category.

5% or fewer students will require Tier 3 services when Tier 1 & 2 services are systemically implemented.


  • Formal assessments
  • Mental health diagnosis
  • School-based therapy
  • Referral for short-term hospitalization (if needed)
  • Possible IEP accommodations
  • Collaboration and record sharing between agency and school
  • Parent/guardian consent

Benefits of the ESMH Framework


  • access to care
  • social functioning
  • emotional wellbeing
  • attendance
  • behavior
  • academic performance
  • early identification and intervention


  • barriers to learning
  • discipline referrals
  • stigma
  • class interruptions

Frequently Asked Questions

Q: Can our school implement Expanded School Mental Health (ESMH) without state DHHR ESMH grant funds?

A: Yes, there are ESMH sites who are funded via diverse means as well as unfunded sites that utilize community partnerships to establish and maintain their ESMH programs.

Q: We are interested in bringing ESMH to our school. How do we get started?

A: First steps, watch our overview video, take a look at our start up guide and check out our brief document on starting a leadership team. Feel free to contact us for more information and with questions at any time.

Q: Is choosing and implementing evidence based programming, at each tier, necessary in ESMH?

A: Yes, evidence based programs (EBP) at each of the 3 ESMH tiers, implemented with fidelity, are vital to successful outcomes. Evidence based programs are proven to work based on research. It is important that your leadership team choose an EBP that matches the identified needs of your student population, secure commitment from and training for those who will implement.