Jennifer McGrory Cooper

Sexual and gender minority youth (SGMY) experience more significant mental health concerns compared to their cisgender and heterosexual peers, especially within recent years, as a result of the relentless political attacks on the lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual+ (LGBTQIA+) community. Given that youth spend the majority of their time in school, it is pertinent that schools invest in prevention and intervention strategies to support LGBTQIA+ youth and address their mental health needs, including strategies to reduce the disproportionate rates of suicide among trans and nonbinary young people. Minority stress theory posits that mental health disparities between LGBTQIA+ youth and non‐LGBTQIA+ youth are a product of structural risk factors, such as discriminatory and homophobic environments, which lead to increased psychological distress among SGM youth. Therefore, in addressing the mental health needs of LGBTQIA+ youth it is imperative that a multitiered system of supports model focuses on systemic changes to enhance the overall school climate through prevention and promotion efforts (tier 1), as well as individualized, direct interventions and coordinated care for students in need of greater support (tiers 2 and 3). To this end, findings from a comprehensive literature review were used to propose a model of tiered school‐based mental health services tailored for LGBTQIA+ youth. Implications for implementation and training focused on prevention and intervention approaches to create LGBTQIA+‐affirming schools for LGBTQIA+ youth are discussed.