Guidelines for Adapting Mindfulness-Based School Interventions with Youth Who Are Racially and Ethnically Marginalized

ABSTRACT

Youth who are racially and ethnically marginalized in the United States are placed at risk for mental health disparities and inequities. We propose that promoting social-emotional competencies through universal school-based service delivery is one potential solution for improving the accessibility and quality of support for these youth. We further propose that mindfulness-based school interventions may be especially useful as universal supports for promoting social-emotional competencies, as they are broadly effective, low-cost, scalable, and flexible. This work unpacks the empirical and logical proposition driving this proposal, and then provides guidelines to help school-based consultants (e.g., school psychologists, counselors, social workers, and other mental health professionals in schools) translate this proposition into practice. Our guidelines have two emphases: first, we offer recommendations for consultants to support implementers in tailoring mindfulness-based school interventions to engage the student population; second, we discuss strategies for consultants to support implementers themselves as they engage with the process of implementing mindfulness-based interventions in schools.

Mental health issues are increasing among adolescents since 2005, with as many as one in five youth suffering from mental illness and many more experiencing psychological distress (Molavi et al., 2018; Twenge et al., 2019). In addition to the elevated general prevalence rate of mental health problems among youth, 7.5 million youth who are racially and ethnically marginalized (Y-REM¹) in the United States have an unmet need for mental health services (Hodgkinson et al., 2017). Recent data for youth and adolescents found the global pooled prevalence of depression (25.2%) and anxiety (20.5%) substantially increased following the COVID-19 pandemic (Racine et al., 2021). Post-pandemic, anxiety, depression, loneliness, stress, and tension are the now the most commonly reported symptoms affecting children and adolescents (Theberath et al., 2022). The COVID-19 pandemic has also substantially impacted the social, emotional, behavioral, mental, physical, educational, and economic well-being of Y-REM (National Academies of Sciences, Engineering, and Medicine, 2023).

Given this context and the mental health experiences of Y-REM, our overarching goal with this paper is to provide practical information that can be used by school-based consultants to promote mental health equity, so all youth have a fair and just opportunity to be mentally healthy (Substance Abuse and Mental Health Services Administration, 2022). Our more specific aim is to convey the potential value of using mindfulness-based interventions in schools as universal supports for promoting mental health equity among Y-REM. We go about this by, first, making an empirical and logical proposition for this effort and then, second, providing guidelines for school-based consultants to translate this proposition to practice.

The proposition

Our proposition for using mindfulness-based interventions in schools as universal supports for Y-REM is comprised of three interconnected premises. The first premise is that Y-REM experience disparities and inequities related to accessing and benefiting from high-quality mental health supports. The second premise is that these disparities and inequities may be at least partially addressed through school-based universal supports that focus on promoting students’ social-emotional competencies. The third and final premise is that mindfulness-based intervention may be an especially useful type of universal support for promoting student social-emotional competencies because it is effective for improving broad outcomes while also being low-cost, scalable, and flexible. We unpack the empirical evidence and logic supporting each of these premises below, and then connect these premises to the role of the school-based consultant.

Disparities and inequities faced by Y-REM

Y-REM who experience chronic environmental stressors (e.g., stressful life events, daily hassles, ambient stressors) and persistent poverty face significant challenges to healthy development (Guski, 2001). Practical barriers (e.g., insurance coverage) and cultural barriers (e.g., beliefs about care) have been shown to disproportionately affect service use among Y-REM (Gudiño et al., 2008). For example, Latinx children have the lowest rate of public or private health insurance coverage of any marginalized group (37%), which is nearly half of their White peers (Strug & Mason, 2001). Furthermore, Y-REM exposed to chronic environmental stress have been shown to have higher rates of internalizing and externalizing disorders relative to their economically advantaged peers (Grant et al., 2006). Since 2017, the Center for Disease Control and Prevention (CDC) indicated that suicide is the first leading cause of death among Asian American youth (Center for Disease Control and Prevention, 2017). Suicide rates have declined among White youth but increased among Black and Asian American/Pacific Islander youth (Center for Disease Control, 2023; Ramchand et al., 2021).

Distress experienced by Y-REM has only been compounded by recent social conditions. During the onset and throughout the COVID-19 pandemic, there has been a greater adverse impact on oppressed subgroups such as those with physical disabilities, sexual minorities, and Y-REM (Hawke et al., 2020). According to the Youth Risk Behavior Surveillance System (YRBSS), high schoolers and middle schoolers reported that their mental health was most of the time or always not good during the COVID-19 pandemic (Center for Disease Control, 2021a, 2021b). The pervasive impact of racial injustices such as George Floyd’s death during COVID-19 and the anti-Asian racism and violence has also impacted the well-being of Y-REM (Addo, 2020; Huynh et al., 2023). Since the pandemic, Latinx and multicultural students were more likely than Asian, Black, and White students to have persistent feelings of sadness or hopelessness. Black students were also more likely than Asian, Latinx, and White students to attempt suicide (Center for Disease Control, 2023).

Unjust social conditions have resulted in Y-REM experiencing environmental imbalance (i.e., deterioration of the environment through depletion of resources) across institutions that is racial, economic, and political, and which can affect their ability to meet developmental and self-actualization tasks (Bounds & Posey, 2022; Causadias & Umaña-Taylor, 2018). Environmental stressors have also contributed to higher rates of poor academic performance, school dropout, and negative social outcomes (e.g., juvenile arrests) among Y-REM (Reynolds et al., 2001). Between 2013 and 2021, findings from the Healthy Minds Study found that mental health worsened for all Y-REM, showing a significant increase in symptoms of depression, anxiety, eating disorders, and suicidal ideation compared to their White peers (The Healthy Minds Network, 2021).

Despite their need for mental health services, Y-REM are unlikely to access high-quality mental health support (Duong et al., 2021; Hodgkinson et al., 2017; Robards et al., 2018). A study found that Black and Latinx youth were significantly less likely than their White peers to access psychological counseling (Lu, 2019, 2020). Barriers to seeking and accessing high-quality mental health support for Y-REM include the cost of services, stigma associated with help-seeking (Abdullah & Brown, 2011; Robards et al., 2018; Stafford & Draucker, 2020), concerns about encountering discrimination (Robards et al., 2018), differences in ethnic and linguistic backgrounds between clinicians and clients (Anderson et al., 2017; Bauer et al., 2010; Robards et al., 2018), clinic staff turnover and burnout leading to poorer quality services (Aarons & Sawitzky, 2006), as well as the availability (or lack thereof) of state and federal funding initiatives that determine what kind of services are available (Aarons et al., 2011). Significant disparities have been documented in Y-REM’s mental health as a result, mainly with African American and Latinx youth (Rodgers et al., 2022).

In addition to these structural and cultural barriers related to accessing support, there are also perceived challenges by clinicians working with Y-REM (Merikangas et al., 2011). For example, research has indicated that Y-REM are suboptimally engaged in treatment, which is evidenced by indices of whether formal treatment is sought, number of visits during treatment, retention in treatment, and follow-up treatment with after-care (Alegría et al., 2008; Interian et al., 2013; Sapiro, 2020). A study also showed that 55 clinicians from mental health and welfare agencies were often unable to identify solutions to reduce mental health disparities among Y-REM. Clinicians’ comments about working with specific populations or about client engagement reflected a presence of barriers rather than the identification of solutions to reduce mental health disparities (Park et al., 2019). Y-REM, especially those with past experiences in systems of care, have unique relational histories to engagement with mental health services (Munson et al., 2015). These youth may come into therapy experiencing disappointment and relationships with family members, clinicians, and other professionals (Lee et al., 2016; Munson et al., 2015). As such, past experiences of trauma, insecure attachment, and negative experiences with providers could contribute to Y-REM being suboptimally engaged in mental health treatment (Munson & Lox, 2012; Munson et al., 2015). Such findings emphasize the continued need to develop and disseminate solutions for engaging and providing effective mental health care with this population (Park et al., 2019).

Promoting social-emotional competencies via universal support

Social-emotional competencies refer to youths’ abilities to apply the knowledge, attitudes, and skills necessary to identify and manage their emotions, take perspective, show empathy for others, set and achieve positive goals, develop and sustain positive relationships, and make responsible decisions (Collaborative for Academic, Social, and Emotional Learning [CASEL], 2012). The intentional and systematic process by which students acquire social-emotional competencies in schools is often referred to as social-emotional learning (SEL). Since mental health disparities exacerbate economic inequities, building social-emotional competencies via SEL at the universal or schoolwide level could be a pivotal approach for improving the wellbeing of youth from marginalized backgrounds (Jagers et al., 2018). Although there are various ways to operationalize social-emotional competencies, one of the most common models is the CASEL (2012) five-factor framework comprising self-awareness, self-management, social awareness, relationship skills, and responsible decision-making.

SEL based on the CASEL framework has proved to be both effective and adaptable. Meta-analyses show that SEL interventions targeting CASEL’s five domains of social-emotional competencies yield meaningful, sustained improvements in youths’ academic and mental health outcomes (Durlak et al., 2011; Taylor et al., 2017). Moreover, specifically relevant with Y-REM, adaptations of the CASEL framework such as transformative SEL critique the marginalization inherent within social systems and are motivated by distributive social justice (Jagers et al., 2019). According to Jagers et al. (2019), issues of culture, identity, agency, belonging, and engagement are relevant to each of the five domains of the CASEL framework mentioned above. The most recent framing from CASEL directly supports these connections, stating that “SEL can help address various forms of inequity and empower young people and adults to co-create thriving schools and contribute to safe, healthy, and just communities” (https://casel.org/fundamentals-of-sel). Thus, universal SEL interventions targeting social-emotional competencies could effectively promote the well-being of youth from communities of color, under-resourced backgrounds, and other marginalized identities, helping to remedy current mental health disparities (Jagers, 2016).

Mindfulness-based intervention (MBI) is one of several approaches to universal SEL. MBI in education is aligned with the goals of SEL, as mindfulness is considered a skill that can be learned like any other skill (Renshaw & Cook, 2017) – and a skill that is relevant to each of CASEL’s (2012) five core social-emotional competencies (see Lawlor, 2016, for a crosswalk of mindfulness skills with core social-emotional competencies). Furthermore, both SEL and MBI initiatives focus on the child’s intentional development of positive self, moral, social, and emotional understanding (Lawlor, 2016). Meta-analyses show that MBI with youth in schools produces similarly positive and broad outcomes as other SEL interventions (Klingbeil, Renshaw et al., 2017). Given the relevance of mindfulness to social-emotional competencies, some researchers have proposed that MBI be considered a specific subtype of SEL (Maloney et al., 2016) whereas others have proposed that integrating mindfulness into traditional SEL can deepen the development of social-emotional competencies (Lawlor, 2016).

We propose that MBI can be conceived as a set of practices for cultivating social-emotional competencies that is especially useful for improving the accessibility and quality of universal school-based mental health support for Y-REM. This proposal is grounded in the logic of multitiered prevention models, which define universal support as “low-intensity services provided to all students within a school population, without regard to risk status” (Merrell et al., 2022, p. 56). The goals of universal support are to promote population wellness, strengthen protective factors, and buffer against emerging mental health concerns (Herman et al., 2019).

Mindfulness-based school interventions as universal support

Mindfulness is defined as the process by which we “pay attention in a particular way: on purpose, in the present moment and nonjudgmentally” (Kabat‐Zinn, 2003, p. 145). MBI refers to any intervention that seeks to cultivate mindfulness skills for the purposes of improving outcomes (Renshaw, 2020). Based on research conducted with adults, MBIs have been shown to be effective for improving various mental health and quality of life outcomes (Brown & Ryan, 2003; Eberth & Sedlmeier, 2012; Grossman et al., 2004). Likewise, several systematic and meta-analytic reviews have shown multiple benefits of MBIs with youth, such as improving resilience, executive functioning, disruptive behavior, academic achievement, externalizing problems, internalizing problems, negative and positive emotions, physical health, and social competence (Kallapiran et al., 2015; Klingbeil, Fischer et al., 2017; Klingbeil, Renshaw et al., 2017; Phan et al., 2022; Zoogman et al., 2015).

Despite extensive empirical support for MBIs with adults and emerging, promising support for MBIs with youth, there is sparse evidence for the effectiveness of MBIs with Y-REM (DeLuca et al., 2018). MBIs with this population have received minimal attention, even with encouraging preliminary evidence that MBIs may be particularly beneficial for chronically stressed youth (Mendelson et al., 2010). Similarly, the National Health Interview Survey suggested that marginalized populations with low education levels are less likely to engage in MBIs; survey data with 69,149 adult participants found that education beyond high school was significantly associated with increased engagement in mindfulness-based practices (Olano et al., 2015). Although the reason for such differences remains unclear, we suggest that those who have higher levels of education may have more exposure, knowledge, and opportunities to engage with MBIs – and, thus, mere exposure effects could account for the lack of engagement among marginalized populations. Furthermore, given the context of the evidence-based practice movement, DeLuca et al. (2018) suggested that the underdeveloped status of evidence supporting the use of MBIs with Y-REM could itself limit the frequency with which MBIs are provided to this population.

Nonetheless, it is noteworthy that studies have also indicated that MBIs are acceptable and engaging for marginalized populations, showing higher program completion rates than other evidence-based treatments (Dutton et al., 2013; Roth & Robbins, 2004). Given that many MBIs are comprised of packages of simple, portable exercises (e.g., mindful breathing and body scan), we further suggest that the very nature of this approach to intervention may help reduce the stigma associated with mental health support – by not necessarily requiring a mental health professional nor a formal mental health treatment setting for effective delivery – thereby increasing acceptability among Y-REM. Furthermore, MBIs are financially low-cost (Miller et al., 1995) and mindfulness exercises, once learned, can be practiced anytime and anywhere, making them a flexible and feasible approach with Y-REM and for school-based consultants working with meager resources.

Mindfulness-based school interventions (MBSIs) generally mirror the structure and format of MBIs conducted outside of schools. MBSIs generally involve 4–24 weeks of instruction in the cultivation of mindfulness, consisting of three components: (1) didactic instruction related to mindfulness, meditation, yoga, and the mind-body connection; (2) experiential practice of various mindfulness meditations, mindful yoga, and the mindful body scan within the classroom; and (3) classroom discussion focused on the application of mindfulness to everyday situations as well as problem-solving barriers to effective practice (Grossman et al., 2004; Kabat-Zinn, 1990). As one of the more intensive examples, the mindfulness education curriculum developed by University of California Los Angeles Health Sound Body Sound Mind (2023) suggests that 10-week lessons implemented one hour per day for one day per week are effective in classroom settings, with each lesson integrating didactic instruction, experiential practice, and classroom discussions. As one of the less intensive examples, Phan et al. (2023) developed a brief teacher-led mindfulness curriculum that was implemented only 10 minutes per day for 2 weeks, comprised of the same three components.

MBSIs can play a critical role in improving students’ school attitudes, behavior, and performance because school-based prevention and intervention have been shown to effectively enhance social, emotional, and academic outcomes (Eva & Thayer, 2017). Y-REM could especially benefit from MBSIs since they experience higher levels of stress and social pressures compared to their advantaged peers (Jackman et al., 2020). Also, given that youth spend a significant portion of their time attending school, MBSIs are likely to be more feasible and accessible for improving the social-emotional competencies of Y-REM compared to most other community-based mental health supports, which are not naturally embedded within youths’ everyday environment. Marginalized youth are also more likely to seek and receive school-based supports compared to clinic-based treatments (Jaycox et al., 2010). Based on a similar line of reasoning, MBIs might be an effective means to reduce observed racial disparities in mental health service utilization and to promote overall student wellness in school settings (Fung et al., 2016; Jones & Lee, 2022).

Although studies have found that MBIs are beneficial in addressing emotional and behavioral problems for Y-REM in a clinic-based settings (e.g., Semple et al., 2010), results have yet to be replicated in larger samples of Y-REM in real-world, public-school settings (Black & Fernando, 2014). Indeed, systematic reviews conducted by Phan et al. (2022) and DeLuca et al. (2018) revealed demographic data that indicate that Y-REM are underrepresented in MBI research. Despite the lacking research with Y-REM specifically, we echo others who suggest that MBSIs could be useful as universal school-based support for enhancing equity for Y-REM because they are more affordable (i.e., free to clients and their families) and more accessible (i.e., embedded within the everyday environment) compared to MBIs offered outside of schools (Juszczak et al., 2003). We also emphasize that using MBSIs as universal support warrants an intentional focus on promoting equity and cultural sensitivity to reach socially just ends (Renshaw & Phan, 2023).

The role of the school-based consultant

Given the systemic nature of schools, the overwhelming demand for student supports, and the traditionally thin ratio of providers to students, school-based mental health providers (e.g., school psychologists, school counselors, school social workers) often spend much – and in some schools, most – of their time engaged in consultative services. Consultation is an indirect, voluntary problem-solving process with the purpose of assisting consultees in developing attitudes and skills that will enable them to function more effectively with Y-REM in the future (Booker, 2009). Given these growing responsibilities, the need for more consultants is evident. With the increasing demands of consultants, the national workforce shortage data reveal that the national average is one school psychologist to every 1,127 students, which is over double the recommended ratio of one school psychologist to every 500 students (National Association of School Psychologists, 2023). Further, a recent survey conducted by the National Association of School Psychologists found that school psychologists spend a majority of their time providing consultation related to instructional support, with 64% of school psychologists reporting they engage in this activity “quite a bit” or “a great deal” of time (Farmer et al., 2021). The American School Counselor Association (2023) and the National Association for Social Workers (2023) also mention that school counselors and social workers play an important role in delivering developmentally appropriate consultation services to enhance the well-being and improve the academic performance of students. Consultation is therefore a core and critical pillar of practice for school-based mental health providers.

Within the practice of consultation, increasing emphasis is being given to the need to center diverse perspectives to ensure that school-based interventions with Y-REM are ethical and equitable (Booker, 2009). In this paper, we provide guidelines for school-based consultants (e.g., school psychologists, counselors, social workers, and other mental health professionals working in school settings) who are promoting social-emotional competencies through universal or schoolwide interventions as one potential solution for improving the accessibility and quality of mental health support for Y-REM. Those receiving support from school-based consultants are referred to herein as implementers (e.g., school-based mental health professionals, community mental health providers, administrators, teachers, paraprofessionals).

Our guidelines rely on the conceptual framework for critical school psychology and the school-based problem-solving consultation model. Critical school psychology aims to uncover ways in which school psychology is complicit in oppression and includes an activist component to transform a school site (Sabnis & Proctor, 2022). School-based problem-solving consultation is a generalizable approach that applies problem-solving processes within consultation relationships to address concerns presenting within a school site (Frank & Kratochwill, 2014). Our guidelines integrate key aspects of critical school psychology and school-based problem-solving consultation by honing in on content and recommendations that are specific to school-based consultants and MBSIs, with the goal of making these interventions more anti-oppressive, contextually sensitive, and geared toward social transformation at the level of the school site.

The guidelines

Given the preceding empirical and logical proposition for using universal MBSIs to enhance equity in youth mental health supports, the purpose of the remainder of this paper is to provide guidelines to help school-based consultants successfully translate this proposition into practice with implementers serving Y-REM. The guidelines have two emphases. First, we offer recommendations for school-based consultants to support implementers in tailoring MBSIs to engage the Y-REM student population. Second, we discuss strategies school-based consultants might employ to support implementers themselves as they engage with the process of implementing MBSIs with Y-REM. A preview and summary of our guidelines are presented in Table 1.

Table 1. Summary of Guidelines and Major Recommendations.

Guideline	Major Recommendations	Application Example
Tailor MBSIs to engage the student population	Use qualitative data for program planning Be flexible with curriculum adaptations	Qualitative example “Something just happened that really upsets and stresses you. Stress is a feeling we get when we feel under pressure caused by a difficult situation. Can you think back to that moment with how your body felt internally? Did your heartbeat faster? Did your body feel more tense? What did you say or do in this situation? What would you do differently if you had a chance to? Was there a way for you to incorporate mindful deep breathing exercises in this situation to reduce your stress level?” Curriculum adaptations by using metaphors “How do you know if someone really cares about you? Are they checking their phone or on Instagram when you’re talking with them? Or are they giving you their full attention? What’s it like to spend time with a good friend? How’s it feel? Mindfulness is like learning to be our own best friend by being present and in the moment in our daily activities.”
Support implementers as they engage with MBSIs	Increase implementer engagement with Y-REM Address barriers in implementer uptake Emphasize mindfulness embodiment by the implementer	Increase engagement Offer many opportunities to engage within the classroom. Develop trust through positive interactions. Entrust students with autonomy. Potential barriers Ask the implementer to identify major anticipated or current barriers to intervention implementation. Ask the implementer to prioritize their top four barriers in order of importance. Identify potential strategies to address those barriers. Mindfulness embodiment “Practicing mindful awareness helps you develop the skill of paying attention in the present moment and learning to see what’s actually happening in your classroom, allowing you to come up with better solutions to the problems you see.”

We intend our guidelines to be complementary to others promoting culturally adapted prevention for children and adolescents across settings (e.g., Gonzales et al., 2016) as well as culturally sensitive interventions with Y-REM in schools (Phan & Renshaw, 2023). We refer readers to Domenech-Rodríguez and Wieling (2005) for more information to guide the process of using culturally affirming evidence-based practice. In addition, it is important to balance fidelity to evidence-based practice with social validity and culturally affirming care, so that Y-REM have a better chance of staying engaged with the intervention and benefitting from it (Bernal & Sáez-Santiago, 2006). We refer readers to Castro et al. (2004) and Cabassa and Baumann (2013) for guidance on balancing cultural adaptations with program fidelity.

Author positionality

Prior to embarking on our guidelines, we would like to acknowledge our positionality related to the subject matter. We represent White, Asian, and biracial/bicultural racial ethnic groups; English and Vietnamese languages; female and male genders; and heterosexual sexualities. One of us holds a doctoral degree and the other is a doctoral student in the field of school psychology. We engage in mindfulness, health equity, school mental health, and school-community collaboration research that is rooted in quantitative, qualitative, and mixed methodologies. We also both have experience implementing MBSIs and maintain personal mindfulness practices outside of our professional roles. Our overlapping identities as both scholars and practitioners of mindfulness motivate a blended perspective grounded in our understandings of the objective (i.e., research literature) and subjective (i.e., lived experience) aspects of the topic. Using the critical school psychology framework (Sabnis & Proctor, 2022), we aim to create new knowledge by producing guidelines that shed light on addressing various social, cultural, and economic inequities in K–12 education.

First Author: My own lived experience as a Vietnamese American growing up with a lower-income background has influenced my interest in mindfulness-based interventions. Growing up where resources were limited, I witnessed the impact the lack of mental health services and financial resources had on my family and peers. Mindfulness-based interventions are financially low-cost, and once learned, can be practiced anytime and anywhere, making them a flexible and feasible approach with Y-REM. My scholarly engagement is interdisciplinary and includes work from social sciences, public health, and humanities. Living in a White-dominant area for graduate school and constantly being marginalized through the state’s policy has pushed me to go beyond the latest research so that I can contribute to positive changes within communities that have been historically marginalized. As a graduate student with various roles and responsibilities, this guideline embodies my continued development of making mental health care more accessible. I believe that everyone should have an opportunity for equal access to resources. When working in real-world settings, it’s crucial to consider how mindfulness-based interventions may affect feasibility and sustainability. With my research, I hope to impact policy within schools to improve mental health outcomes for marginalized youth.

Second Author: My interest in mindfulness is grounded in scholarly research mixed with lived experience. I have been a school psychology researcher for 12 years, conducting primarily quantitative and synthesis research on this topic and others. During this time, I have trained and supervised graduate students in providing MBIs in schools, both via direct intervention and consultation, which has often required stretching beyond the limits of published knowledge on the topic. I have also, for the last 5 years, struggled to apply mindfulness in my parenting with one of my children, who lives with a significant disability. I have observed the benefits of mindfulness first-hand for myself, my family, my graduate students, my clients, and for participants in our research. I believe the dialectic between knowledge gained from research and wisdom gained from lived experience should be valued and cultivated in mindfulness scholarship, as well as in all areas of applied psychology and education. As a person who identifies with majoritized identities in almost every way (i.e., White, male, cisgendered, straight, abled), I strive to be an ally and to use my privilege and positionality to advance social justice. I believe disseminating and implementing mindfulness-based interventions is one way (among many possible ways) for me to help promote mental health equity in schools.

Tailor MBSIs to engage the student population

Our first guideline is to support implementers in tailoring MBSIs to engage the student population (Sabnis & Proctor, 2022). To operationalize this guideline, we recommend that school-based consultants support implementers in (a) using qualitative data for program planning and (b) being flexible with program adaptations.

Given that Y-REM have been reported to be suboptimally engaged in treatment (Merikangas et al., 2011), it is critical for the school-based consultant to raise implementers’ awareness regarding when students seem less engaged and support them in adapting MBSIs to be applicable for the students by increasing engagement in the classroom. In addition, it is important to note that Y-REM may be suboptimally engaged with interventions due to structural barriers (e.g., financial, legal, cultural, community attitudes) as well as barriers connected to their age and developmental level (e.g., confidentiality concerns, embarrassment, shame, fear of being judged; Patton et al., 2016; Sebastian et al., 2014). This may impact Y-REM engagement in classrooms due to the lack of knowledge about their ability to advocate for themselves, communicate effectively, and the ability to follow through with plans made with consultants (Sebastian et al., 2014). It is imperative that school-based consultants help implementers understand that being aware and accepting of one’s own painful thoughts and emotions, making distinctions between self and emotions, and applying self-compassion are crucial processes for Y-REM to realize the need for and benefits of mindfulness practice (Hwang et al., 2019).

Use qualitative data for program planning

School-based consultants can support implementers to increase Y-REM engagement in the classroom through MBSIs as one potential option for increasing accessibility to mental health supports made unavailable by structural barriers. When it comes to complex constructs with structural consequences, such as race, it is essential to consider epistemological diversity to accept and celebrate different ways of knowing and understanding (Sabnis & Proctor, 2022). We suggest consultants encourage implementers to use qualitative data in order to better understand and meet youths’ needs.

To best develop and refine MBSIs, it is critical for consultants to help implementers explore the stressors experienced by Y-REM and whether mindfulness practice can help them better navigate these stressors. There is research showing that youths’ perceived stressors differ in early, middle, and late adolescence, and that such stressors are usually situation specific (Seiffge‐Krenke et al., 2009). Previous studies on MBSIs have measured stress levels and related outcomes via quantitative measures (Schonert-Reichl & Lawlor, 2010; White, 2012). However, using qualitative data as a touchstone of treatment planning – outside of outcome assessment – has the additional advantages of informing the way school-based consultants design interventions and how, in turn, the implementers can engage Y-REM with MBSIs. Specifically, we recommend that school-based consultants aid implementers in qualitatively evaluating how Y-REM define their stressors, the sources of their stressors, and the applicability of MBSIs to their stressful experiences.

A good example of this recommendation in practice has been incorporated by Dariotis et al. (2016), who emphasized their approach to asking youth to define stress and stress-management (e.g., “What does stress mean to you?,” “What do you think other youth should know about youth and stress?,” “What did you learn about stress in the program?,” and “Have you used what you learned in the program outside the program to help you with stress?”). In a classroom setting, it may be beneficial for the implementers to give students time to think through the questions and then break out into small groups to have them discuss their answers with each other. After the break-out groups, students can then discuss their experience and answers with the entire classroom, which can build connection, decrease boredom, and encourage a sense of community with peers (Chandler, 2016).

When recommending interviewing youth about their understanding of their stress, there are a few guiding principles school-based consultants should keep in mind. First, some youth may have a hard time distinguishing anger and other negative emotions from stress. A qualitative study showed that Y-REM defined their stress as unpleasant emotional experiences, which included minor annoyances, irritations, and frustrations that were beyond the current situation affecting their lives (Dariotis et al., 2016). Second, youth may not properly recognize stress as a state of feeling overwhelmed and unsure of how to cope, which could lead to negative emotions (Dariotis et al., 2016). As a result, we recommend school-based consultants discuss with implementers how stress is separate from negative emotions (i.e., stress responses include negative emotions, such as depression, anxiety, anger, but are not synonymous with these emotions), highlighting that more positive emotions (e.g., joy, interest, contentment, pride) may be beneficial during times of stress by reducing negative emotional reactivity and quickening recovery from stressful events (Du et al., 2018; Leger et al., 2020).

Focusing on this distinction – clarifying one’s experiences of subjective distress (e.g., the discomfort, pain, uncomfortable feelings one might experience) in relation to their ability to respond effectively to stressful situations – could help promote a sense of empowerment in Y-REM, especially when emphasizing how mindfulness is beneficial for both purposes. For example, the school-based consultant might suggest the implementer to say something like the following: “Something just happened that really upsets and stresses you. Stress is a feeling we get when we feel under pressure caused by a difficult situation. Can you think back to that moment with how your body felt internally? Did your heartbeat faster? Did your body feel more tense? What did you say or do in this situation? What would you do differently if you had a chance to? Was there a way for you to incorporate mindful deep breathing exercises in this situation to reduce your stress level?”

Another guiding principle to keep in mind when recommending interviewing youth is to recognize the socioeconomically disadvantaged environments that youths may live in, which could involve circumstances that require the youth to assume adult-like responsibilities in their family. For example, Dariotis et al. (2016) found that disrupted or insufficient sleep resulting from tiredness was a common source of stress for youth, yet this problem often stemmed from expectations to care for younger siblings. To address this issue, one might ask Y-REM, “What do you like about being at home? What don’t you like about being at home? Who is there to support you when you feel you need it at home?” Although reducing financial hardship and structural inequalities are extremely difficult to achieve without system-level changes, helping youth change how they manage stressful experiences is likely to increase their sense of empowerment, agency, and hope. School-based interventions, like MBSIs, could therefore help Y-REM better manage the adult-like stressors they experience.

Be flexible with curriculum adaptations

After the known stressors are established from the youths’ perspective, the school-based consultant should emphasize to implementers that it is important to be flexible and make – or be open to making – minor curriculum adaptations in order to better meet youths’ needs (Bluth et al., 2016). In line with the critical school psychology framework, we encourage creating an oppositional space where an organizational practice sustaining oppression is interrupted (Sabnis & Proctor, 2022). An example of creating oppositional space is when a school psychologist highlights the disproportionately high number of discipline or special education referrals for Black students compared to White students within the school (Sabnis & Proctor, 2022).

One key area of disrupting oppression is adjusting the complexity of language used throughout the curriculum (Sibinga et al., 2011). Knowledge of students’ developmental level and vocabulary is critical for informing effective communications with them, especially when introducing a new activity or intervention like MBSIs (Dariotis et al., 2016). For the implementers, modifications in language can involve simplifying the language used to describe mindfulness practice and activities. For example, when talking to the classroom about decentered observation of thoughts, the school-based consultant can suggest the implementers adjust the technical language to describe how one can get “hooked by thoughts” and “stuck in their head” (Coyne et al., 2011), which are more colloquial and memorable phrasings than traditional mindfulness terminology. As another example, the school-based consultant might suggest the implementer say to the classroom, “How do you know if someone really cares about you? Are they checking their phone or social media apps when you’re talking with them? Or are they giving you their full attention? What’s it like to spend time with a good friend? How does it feel? Mindfulness is like learning to be our own best friend by being present and in the moment with our daily activities.”

We also recommend school-based consultants suggest that implementers make frequent use of stories, metaphors, and real-life examples that relate directly to Y-REMs’ lived experiences and help ground mindfulness exercises in relatable events (Miller et al., 2006). For instance, it may be helpful to have the classroom openly share what activities they enjoy or have interest in, such as a sports or music, and then use that context to explore what really “being in the moment” with that activity feels like for them. It is important that the adaptations remain evidence-based, so that the core components of the MBSI curriculum are not lost. Adapting a curriculum to be culturally sensitive preserves the essential components of an intervention while tailoring or including relevant references to increase applicability and engagement for Y-REM (Phan & Renshaw, 2023). For example, if the MBI is comprised of six one-hour sessions, and this frequency or duration interrupts the flow of the classroom, the intervention may be adjusted to six 30-minute sessions, with additional home practice. Further, if the mindfulness exercises include predominantly White names and examples, the school-based consultant can recommend that implementers change the examples to include culturally unique names and cultural experiences that may be more relevant to the students in the classroom.

Support implementers as they engage with MBSIs

Our second guideline is to specifically support implementers themselves as they engage in the process of implementing MBSIs. Given school-based consultants may work with a variety of implementers providing MBSIs (e.g., school-based mental health professionals, community mental health providers, administrators, teachers, paraprofessionals), this last section will discuss how they can directly intervene with implementers of MBSIs to help them work more effectively with Y-REM in schools. Whereas the first guideline emphasized strategies implementers can use to tailor MBIs with Y-REM, this second guidelines emphasizes interpersonal and intrapersonal considerations for implementers to help them more effectively engage with MBSIs with Y-REM. Specifically, we recommend school-based consultants can support implementers by (a) providing strategies for implementers to increase engagement with Y-REM, (b) addressing potential barriers in implementer uptake of mindfulness practice, and (c) discussing how mindfulness embodiment may personally benefit implementers. We also emphasize that it is important for consultants to have a basic level of knowledge and competence in MBSIs prior to supporting implementers in aspects of this second guideline.

Increase implementer engagement with Y-REM

First, we turn to the topic of strategies school-based consultants might employ for helping implementers promote youths’ engagement with MBSIs in the classroom. In order to connect and build trust with Y-REM, it is crucial for implementers who do not identify as a person of color to be aware of their own Whiteness and to avoid falling into the “White savior” mindset (Yu, 2021). This mindset is geared toward those with privileged identities (e.g., White, mid – high socioeconomic status), and is characterized by thinking that they know what those with targeted identities (e.g., members of social identity groups who are discriminated against, marginalized, disenfranchised, oppressed, or exploited by an oppressor and oppressor’s system of institutions) need and how that need should be met (Goldbach, 2017; Matias, 2016). Consultants can help raise awareness and cultivate sensitivity to these concerns by providing implementers with resources and trainings geared toward these topics.

For example, according to Blum (2014), teachers are advised to have training – beyond mindfulness – in practices and competencies that support their sensitivity and efficacy in working with Y-REM (i.e., anti-racism training, class awareness, feminism, and nonviolent communication). Having additional training in these areas may better prepare teachers and other implementers to understand and empathize with students while implementing MBSIs (Blum, 2014). School-based consultants may want to recommend these trainings if implementers express challenges in building a connection and trust with Y-REM. For example, members of the Insight Meditation Community of Washington formed a group in which participants meet monthly to examine the history of White privilege and its manifestation on their lives. Participants reported supporting each other in “actively dissolving systemic racism” (Blum, 2014). Other programs such as Insight Meditation Center of Pioneer Valley (2021) and New York Insight (2021) also offer these trainings to build authentic relationships across racial identities within the context of mindfulness practice.

Furthermore, we recommend that school-based consultants help implementers to reframe common misconceptions and stereotypes about Y-REM, which could negatively affect implementation of MBSIs in the classroom. Bryan and Atwater (2002) noted the two most common and problematic beliefs held by teachers about Y-REM are: students from culturally diverse backgrounds are less capable than other students, and teachers should treat all students the same – regardless of their class, gender, or race. Teachers and other implementers who hold the belief that culturally diverse students are less capable than other students tend to have less ambitious learning goals, provide students with less autonomy, allow less interaction between students, and rely more heavily on passive teaching methods (Bryan & Atwater, 2002; Johnston et al., 2019). As a result, teachers tend to give more positive ratings to students when they share a similar racial and ethnic background, but have more conflict with and lower expectations of Y-REM (Gay, 2018; Gershenson et al., 2016; Namrata, 2011).

To counteract these tendencies when implementing MBSIs, implementers should encourage group discussions of the intervention and allow students to have some degree of power and freedom over the structure (Moll et al., 1992). If students refuse the intervention because they perceive it as imposed on them, implementers should be encouraged to allow students to maintain self-determination, participate whenever they are ready to do so, and give alternative options for engagement at that time. Such shared power may improve the quality of student–teacher relationships, which, in turn, promotes better student outcomes (Banks & Banks, 2019; Bryan & Atwater, 2002; Gay, 2018). That said, many implementers may have difficulty in supporting shared power of the MBSI, which allows school-based consultants an opportunity to offer classroom observations and provide targeted and supportive implementation feedback. If teachers and other implementers do not seem receptive to shared power, it would be helpful for school-based consultants to explain how students tend to be more cooperative when there is shared power, whereas students who feel they have less power are more likely to rebel (Association for Supervision and Curriculum Development, 1997). If the school-based consultant senses that the implementer is still having difficulty with shared power, it may be useful to set up a meeting to identify barriers and problem-solve around this topic.

In the same way, promoting youths’ self-determination in engaging with MBSIs is also consistent with ethical guidelines regarding obtaining minors’ assent for participating in psychological interventions generally (American Psychological Association, 2002) as well as school-based interventions specifically (National Association of School Psychologists, 2020). Given the flexibility required of MBSI classroom implementation with Y-REM, we suggest it is worthwhile for school-based consultants to check in with implementers regularly to formally evaluate their implementation challenges and provide consultation and support for resolving any pressing concerns. Likewise, we encourage school-based consultants to notice and have an open conversation if implementers appear to treat all students the same regardless of their class, gender, or race, given they are likely employing interpersonal methods that do not take into account the heterogeneity of educational and cultural backgrounds among Y-REM (Bryan & Atwater, 2002). Treating all students the same ignores cultural variations in learning-related social interactions, and social interactions are inherent in all aspects of MBSIs.

Instead of a one-size-fits-all approach, consultants can encourage implementers supporting MBSIs with Y-REM to employ several potentially helpful strategies to improve engagement, including (a) using illustrations to aid comprehension with English language learners, (b) allowing for choice among mindfulness activities (e.g., mindful breathing vs. walking vs. eating vs. yoga), (c) emphasizing how mindfulness is helpful in youths’ day-to-day lives using culturally relevant exemplars, (d) allowing opportunities for students to converse with each other related to mindfulness practice, and (e) providing students with the option to practice mindfulness in groups or as individuals (Bryan & Atwater, 2002). Consultants can support implementers in engaging a problem-solving process to determine which of the aforementioned engagement strategies may be more or less relevant within a given implementation situation.

Address barriers in implementer uptake

In addition to providing strategies for implementers to increase engagement with Y-REM, it is also important to address potential barriers in implementer uptake with mindfulness practices. Studies have shown that lack of time, inadequate training, and knowledge are common barriers for teachers to implement MBSIs in the classroom (Enrico, 2017; Gonzales, 2018; Phan et al., 2023). However, exposure to mindfulness concepts, practices, and resources have been shown to increase willingness of teachers to adopt MBSIs in classrooms (Munk, 2020). Further, it may be helpful for consultants to ask the implementer to identify major anticipated or current barriers to the MBSI implementation (e.g., remembering too many steps, dislike of the intervention, not enough time for preparation, managing a new responsibility). When incorporating MBSIs, implementers may be resistant to change, unwilling to take on more work, and in some circumstances, mindfulness might seem misaligned with their personal religious beliefs or cultural values. In this case, it may be especially helpful to ask the implementer to prioritize their top four barriers in order of importance (1 = highest priority, 2 = second highest, etc.). Once information is received about potential barriers, consultants can support implementers in engaging a problem-solving process to identify potential strategies to address those barriers.

Consultants may also support implementers around time commitment or bandwidth concerns. Specifically, it is important for teacher implementers to perceive that the intervention is not mandated by the school-based consultant, since they may see it as an additional task that detracts from their already scarce time and resources in the classroom (Grant, 2017). Moreover, if implementers express interest in mindfulness but show hesitance due to time constraints, we suggest it might be useful for the school-based consultant to encourage the implementer to engage in experiential mindfulness activities, such as guided meditations (see https://www.uclahealth.org/marc/mindful-meditations for several free audio recordings that can be streamed or downloaded) or app-based exercises (see https://onemindpsyberguide.org/apps/ for a review of relevant mindfulness apps) to increase their exposure to MBIs. Engaging in mindfulness exercises outside of the implementation situation may help teachers or other implementers realize that such exercises can be time-efficient and easily integrated within regular school routines (e.g., mindful walking and eating).

Along these lines, consultants can also advocate for a mindful culture in the broader school environment to better support implementers who are interested in but wary about MBSIs. A recent study found that it was valuable for teachers to be surrounded by a mindful culture and to have the support of their colleagues, parents, local school leadership, families, and community organizations, such as universities and health agencies (Albrecht, 2018). When implementers feel a lack of support from key personnel in this area, the implementation of MBSIs may result in discouragement and therefore resistance to uptake. Furthermore, it is noteworthy that Albrecht (2018) found that rushing to integrate MBSIs was perceived as problematic for teachers. Instead, teachers preferred that mindfulness training and practice proceed at a slow and gradual pace pre-implementation. Consultants may do well to generalize these observations with teachers to all implementers engaging in the process of implementing MBSIs with Y-REM.

Given these findings, it is essential for school-based consultants to intentionally address and balance implementers’ concerns when supporting their implementation of MBSIs. We recommend that school-based consultants be sensitive to implementer variables pre-implementation, then continue to encourage and support implementers in their implementation throughout the duration of the intervention. Ultimately, with the approval and enthusiasm of implementers, uptake and implementation of MBSIs will be more successful and, therefore, more likely to benefit Y-REM.

Emphasize mindfulness embodiment by implementer

Finally, we suggest school-based consultants can support implementers in using MBSIs by helping them cultivate a personal mindfulness practice that allows opportunity to engage in examining their own experience, which they can then draw on to more authentically relay to the students (Crane et al., 2010). Additionally, there are multiple potential mental health benefits for teachers and other implementers who practice mindfulness themselves. Studies have shown that mindfulness interventions enhance teacher well-being by reducing stress, burnout, anxiety, and depression (Beshai et al., 2016; Roeser et al., 2013) as well as by increasing mindfulness, self-compassion, and emotion regulation (Jennings et al., 2011, 2013). Indeed, a meta-analysis conducted by Klingbeil and Renshaw (2018), which included 29 studies and 347 effect sizes, found that MBIs with teachers consistently improved their mindfulness, increased their well-being, and decreased their psychological distress.

Crane et al. (2010) highlight the importance of mindfulness embodiment by the teacher before implementing MBSIs with Y-REM. Mindfulness embodiment requires adequate training and an intensive personal practice of mindfulness in daily life (Crane et al., 2012). It is recommended that mindfulness embodiment and having a personal connection to mindfulness are prerequisites for being an adequate mindfulness implementer (McCown et al., 2010; Santorelli et al., 2017). As such, research has found that implementers prefer to connect deeply with mindfulness practices before implementing the intervention in the classroom by taking a “personal mindfulness journey” (i.e., reflecting on mindfulness texts, theories, and practices; taking the time to connect with their own personal wisdom; Albrecht, 2018). To explain the importance of mindfulness embodiment to a teacher implementer, for example, the school-based consultant might say something like the following: “Practicing mindful awareness helps you develop the skill of paying attention in the present moment and learning to see what’s actually happening in your classroom, allowing you to come up with better solutions to the problems you see.” These same approaches could be generalized by consultants to all implementers within the school context.

School-based consultants can help implementers get acquainted with mindfulness practices by guiding them with the following two-step instruction. The first step is to instruct implementers to slow down and notice what they are experiencing in the present moment, which enables enhanced awareness, acceptance, and emotion regulation to take hold. The second step is to encourage implementers to practice acceptance toward these experiences, which includes at least two sub-processes: the realization that being emotional and experiencing failure is part of being human, along with a capacity to separate the stable experience of oneself from one’s fleeting feelings and thoughts (Hwang et al., 2019). Consultants could use this simple two-step instruction with implementers in various contexts throughout the school setting and even at multiple times during the school day.

If the consultant feels uncomfortable guiding implementers in this brief practice themselves, they could instead encourage the implementer to practice mindfulness in that moment with them by playing a recording of a short mindful breathing or body scan meditation that they can participate in together (e.g., University of California Los Angeles Health, 2023). Alternatively, if implementers appear short on time or feel uncomfortable practicing mindfulness with the consultant, the consultant could recommend that implementers download any of the free mindfulness apps (e.g., mindfulness.com, Insight Timer, Smiling Mind, UCLA Mindful, Healthy Minds Program) and provide brief instruction regarding how to use the app to self-practice whenever the implementers have time to do so.

In order to help teachers and other implementers build their authenticity in mindfulness, we suggest school-based consultants invest in a personal mindfulness practice themselves – and then share their own authentic experiences with teachers and other implementers about how mindfulness practice has impacted their personal well-being. In other words, we recommend consultants “practice what they preach” on this topic.

In the end, many implementers may embrace mindfulness, yet others may not. Despite how individual implementers respond, we encourage consultants to approach their work in supporting implementers using MBSIs in a spirit of mindfulness, which is attentive and accepting of whatever attitudes and experiences implementers bring into the consultative relationship. Most importantly, we recommend consultants consider the growing evidence that teachers influence their students not only by how and what they teach but also by how they relate, teach, and model social-emotional competencies in the classroom (Jennings & Greenberg, 2009). If school-based consultants sense that teachers and other implementers are hesitant to practice mindfulness or implement MBSIs with Y-REM, we suggest it may be helpful to gently remind them that enhancing their own mental health is likely to support their desires to become better teachers, which, in turn, is likely to result in improved student outcomes.

Conclusion

Given the need to enhance equity in youth mental health supports and the potential of MBIs as universal prevention, the overarching purposes of this paper were to make the case for using MBIs as schoolwide prevention and provide guidelines to help school-based consultants successfully translate this proposition into practice. Specifically, we overviewed strategies for supporting implementers in tailoring MBSIs to engage the student population and strategies for supporting implementers themselves as they engage in the process of implementing MBSIs with Y-REM (see Table 1 for a summary of our guidelines).

Considering the scope of our paper and its focus on MBIs as universal prevention in schools, we wish to highlight the need to implement school-based mental health services beyond this level for Y-REM who may require more targeted or intensive mental health support. The field of MBSIs is promising, yet more research is needed to establish a robust selection of high-quality, evidence-based mindfulness programming that is intentionally optimized for treatment purposes in school settings (Renshaw, 2020; Renshaw et al., 2022). Thus, our guidelines emphasized only the more well-established level of MBSIs as universal prevention. Toward this end, we recommend that future work on MBSIs focus on using implementation science principles to address the practice-to-knowledge gap at more intensive levels of support with Y-REM (e.g., Fuchs et al., 2013; Jennings, 2023; Owens et al., 2014).

We also recognize that the inequities and disparities experienced by Y-REM in educational settings are complicated by systemic political, social, economic, and cultural barriers. As a result, Y-REM are more vulnerable to stressors and are at higher risk for trauma (Virginia Department of Education, 2023). The long-term consequences associated with these inequities and disparities include stress and anxiety, exclusion from groups, and low motivation in adulthood. Further, Y-REM experience higher rates of suspension and expulsion and have higher risk of poor school performance, school dropout, arrest, incarceration, and unemployment (Virginia Department of Education, 2023). Considering this context, we hope our guidelines may empower school-based consultants to join in mental health equity work that provides more opportunities for more Y-REM students to develop social-emotional competencies that may prevent and alleviate problems while simultaneously promoting their well-being and academic success.

Finally, we acknowledge that there is currently little research guiding how school-based consultants should be effectively working with Y-REM, especially when supporting the implementation of MBSIs. We therefore urge researchers interested in MBSIs and consultation to empirically investigate our guidelines for the purposes of advancing best practices for supporting Y-REM at the universal level in schools.

Acknowledgment

The lead author would like to thank everyone, especially members of ARCH Lab at the Penn Center for Mental Health, who played a role in her academic accomplishments through their love and support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Partial funding for this work was provided to the lead author through a Health Policy Research Scholarship from the Robert Wood Johnson Foundation.

Notes on contributors

Mary L. Phan

Mary L. Phan is a fourth-year PhD school psychology student at Utah State University. I am interested in implementing mindfulness-based interventions (MBIs) with marginalized youth in public schools as well as promoting racial equity through policy changes. Using a community-based participatory research approach, I collaborate with key partner within the schools and community to implement MBIs for marginalized youth. MBIs are financially low-cost, and once learned, can be practiced anytime and anywhere, making them a flexible and feasible approach with diverse populations. When working in real-world settings, it’s crucial to consider how shared values may affect feasibility and sustainability when implementing MBIs. Considering these factors, I am researching how teachers could play a pivotal role in encouraging students to practice MBIs if they themselves also practice mindfulness and implement MBIs in their classrooms. With my research, I hope to impact policy within schools to bolster the effect of improved mental health outcomes for marginalized youth.

Tyler L. Renshaw

Tyler L. Renshaw is Associate Professor and Director of the School Psychology Program within the Psychology Department at Utah State University. My research aims to improve the accessibility and quality of school-based mental health services, with particular focus on mindfulness-based interventions and brief assessment practices. I hold a PhD in Combined Clinical, Counseling, and School Psychology from the University of California at Santa Barbara and am a licensed psychologist and Nationally Certified School Psychologist.

Notes

¹ The American Psychological Association (2021) defines marginalization as “relegation to or placement in an unimportant or a depowered position in society” (p. 4). The phrase youth who are racially and ethnically marginalized (Y-REM) can therefore represent children and adolescents with varying backgrounds, identities, and characteristics. In this paper, we define Y-REM as those 5–19 years old who are racially and ethnically marginalized (e.g., Black, Indigenous, and People of Color) – excluded from social, economic, and/or educational opportunities enjoyed by other youth in their community due to numerous factors beyond their control (Auerswald et al., 2017). The specific opportunity we are concerned with in this paper is access to high-quality mental health support. Thus, for the remainder of the paper, we use the phrase Y-REM to refer to youth who (a) do not have access to mental health support or who, despite having access, (b) do not receive high-quality mental health support because they have been marginalized by society.