Getting “SMART” about implementing multi-tiered systems of support to promote school mental health

Abstract

With the growing adoption and implementation of multi-tiered systems of support (MTSS) in school settings, there is increasing need for rigorous evaluations of adaptive-sequential interventions. That is, MTSS specify universal, selected, and indicated interventions to be delivered at each tier of support, yet few investigations have empirically examined the continuum of supports that are provided to students both within and across tiers. This need is compounded by a variety of prevention approaches that have been developed with distinct theoretical foundations (e.g., Positive Behavioral Interventions and Supports, Social-Emotional Learning) that are available within and across tiers. As evidence-based interventions continue to flourish, school-based practitioners greatly need evaluations regarding optimal treatment sequencing. To this end, we describe adaptive treatment strategies as a natural fit within the MTSS framework. Specifically, sequential multiple assignment randomized trials (SMART) offer a promising empirical approach to rigorously develop and compare adaptive treatment regimens within this framework.

Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1)

“…MTSS models thus accentuate prevention, frequent progress monitoring, data-based decision-making and problem-solving, evidence-based interventions, individualized instruction and intervention, and implementation fidelity (Eagle et al, 2015). The comprehensive, empirical, sustainable, and efficient nature of MTSS is designed to optimize limited resources and is thus becoming widely adopted in school settings (McIntosh et al, 2010; August et al, 2018).…”

Family Environment Variables as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis

“…A better understanding of how these needs intersect with family-based challenges is essential in this respect. Parental involvement, for example, has been found to be a key element of success in MTSS programs, and such programs often benefit from a wider array of stakeholders that include parents (August et al, 2018). In addition, MTSS models are increasingly moving toward a “whole child” approach that more fully considers ecological levels outside of school, such as family factors (Sailor et al, 2018).…”

“…MTSS models are often arranged in three tiers that focus on prevention (Tier 1), early intervention for emerging, acute problems (Tier 2), and intensive intervention for chronic and severe problems (Tier 3; Eagle et al, 2015). MTSS models have been applied to academic, social, and behavioral problems and skills across various age ranges and school settings (August et al, 2018).…”

Using Conjoint Analysis to Predict Teachers’ Preferences for Intervention Intensity

“…MTSS consists of three tiers ranging from less intensive, universal services to more intensive, individualized services (August, Piehler, & Miller, 2018;Fabiano & Evans, 2019). Under the MTSS model, school personnel (e.g., teachers, counselors, school psychologists, administrators) undergo a data-driven problem-solving approach to assess students' needs and plan appropriate interventions to implement.…”