The Multi-Tiered Systems of Support (MTSS) is a framework for organizing mental health systems. It is divided into 3 primary service delivery tiers that rest on a foundation of professional development, family-school-county-community partnerships, and strategies for continuous quality improvement.
The MTSS framework is designed to ensure consistency of structure, while simultaneously offering flexibility regarding the components of each of its 3 tiers. The system and its tiers are used for systems level design. They are not intended to be used at an individual level, and do not represent a diagnostic category or designation for a student. Rather, they refer to the level of services within a system that a student requires.
Schools and school districts fulfill an essential role in promoting and supporting the mental health and well-being of their diverse communities. The mental health and health systems and resources they offer to students, families, and staff depend on their constituents’ unique needs.
The 3 tiers include:
Primary Prevention: Universal strategies for promoting mental health and providing health and mental health supports that are available to all within a community. Examples include mental health literacy; strengths-based, trauma- and SEL-informed, equity-centered supports; school staff health and well-being; care, connection, and belonging/positive school climate and culture; and suicide and substance use prevention.
Secondary Prevention: Selected supports to promote mental health and well-being, and connect individuals to group supports or referrals to higher tier providers. Tier 2A focuses on early identification and support for students with mental health concerns. Examples include mental health service referral; essential health and well-being needs; coordination with referred providers; initial suicide risk assessment; check-ins; resource plans; and skill groups.
Secondary Prevention: Indicated services for those with identified needs that exceed 2a supports. Includes formal assessment, referral, and targeted interventions. Tier 2B (Indicated Services) focuses on strengths-based target services for students with identified mental health concerns. Examples include strengths-based small group therapy; brief targeted therapy; mental health service referral; coordination with referred providers; and suicide risk assessment, referral, and safety planning.
Tertiary Intensive Services and Crisis Support: Targeted referrals and services for those with more serious or critical mental health and health concerns who require intensive services and follow up. This tier focuses on targeted referrals for students with serious concerns that impact daily functioning. Examples include individual therapy; family therapy; treatment for suicidality; postvention response; and substance use treatment.
In education, an MTSS framework delineates the primary responsibility of education systems and their community partners. In general, schools and districts bear the primary responsibility for delivering foundational supports, and Tiers 1 and 2a. Community partners including community-based mental health agencies, county behavioral health services, community care organizations and other credentialed mental health providers hold primary responsibility for delivering mental health and health services for Tiers 2b and 3.