Multi-Tiered Systems of Support for Mental Health: A Comprehensive Review Series
Mental health disorders affect a significant portion of American youth, with nearly 20% of children and young people ages 3-17 in the United States having a mental, emotional, developmental, or behavioral disorder (Agency for Healthcare Research and Quality, 2022). Schools have emerged as critical settings for addressing these challenges through Multi-Tiered Systems of Support (MTSS) frameworks, which provide systematic approaches to supporting student mental health across multiple levels of intervention intensity.
This two-paper series provides a review of school-based mental health interventions within MTSS frameworks, offering evidence-based guidance for educators, administrators, and mental health professionals seeking to implement effective support systems.
Paper 1: MTSS Tier 1 – Universal Mental Health Interventions
The first paper focuses on Tier 1 universal interventions designed to support all students within a school community. These foundational programs aim to promote positive mental health, build protective factors, and prevent the development of mental health difficulties through whole-school approaches. The paper reviews evidence across multiple intervention types including Social Emotional Learning (SEL), life-skills training, mindfulness-based programming, physical activity and after school activities initiatives.
Readers will find comprehensive review of universal interventions that have demonstrated effectiveness in building emotional regulation skills, enhancing peer relationships, reducing behavioral problems, and creating supportive school environments. The paper addresses implementation considerations, cultural responsiveness, and strategies for reaching diverse student populations through prevention-focused approaches.
Paper 2: MTSS Tiers 2 & 3 – Targeted and Intensive Mental Health Interventions
The second paper examines Tiers 2 and 3 interventions designed for students with elevated mental health needs. Tier 2 provides targeted support for at-risk students showing early warning signs or experiencing mild to moderate symptoms, while Tier 3 delivers intensive interventions for students with significant clinical-level concerns or diagnosed mental health disorders.
This review synthesizes evidence on specialized interventions including Cognitive Behavioral Therapy adaptations, mindfulness-based interventions for clinical populations, resilience programming, physical activity programs and more. The paper provides an overview of diverse student populations served by these interventions, including economically disadvantaged youth, culturally marginalized students, immigrant and refugee populations, students with disabilities, and those with diagnosed mental health conditions.
Readers will gain insights into evidence-based practices for supporting vulnerable student populations, implementation frameworks for intensive interventions, equity considerations in service delivery, and the specialized training requirements for delivering clinical-level school-based mental health support.
Significance for Practice
Together, these papers provide a roadmap for building prevention-focused universal supports while ensuring that students with more intensive needs receive appropriate clinical-level interventions within educational settings.