What is MTSS-B?

Overview of MTSS-B

NH’s Multi-Tiered System of Supports for Behavioral Health and Wellness (MTSS-B) framework is a comprehensive system of social, emotional, and behavioral supports to promote student wellness and improve engagement in learning. Based on the Interconnected Systems Framework (ISF), MTSS-B blends research-based school mental health practices and social-emotional learning with a tiered prevention framework.

Core Features

Student and school wellness is an articulated district priority. Social-emotional learning and mental health are integrated throughout school culture, including schoolwide curricula and classroom management, as well as interventions for those with higher needs.

School, mental health, community, and family partners collaboratively develop an intentional, integrated approach to choosing and implementing evidence-based interventions to support student behavioral health needs.

Supports are delivered across three tiers: Tier 1 schoolwide/universal approaches for all students, Tier 2 targeted supports for at-risk students, and Tier 3 individualized services for the highest-need students.

MTSS-B implementation is monitored by ongoing measurement of: (1) reach – the who, what, where, and when of practice delivery; (2) fidelity – the degree to which the framework is implemented in a way that is faithful to the guiding model; and (3) outcomes – at both the individual student and school levels.

Systematic Approach

1. Mobilize People

MTSS-B relies on the development of collaborative, multi-sector teams at all levels. An executive-level Exploration Team first determines need and potential fit of MTSS-B. Then, an expanded District-Community Leadership Team sets priorities, action plans, and secures resources for implementation. School-based tiered teams oversee implementation of MTSS-B practices, using data to select, improve, implement, and evaluate the systems that serve students’ social-emotional and behavioral health needs.

2. Use Data

The use of data to inform action planning and progress monitoring is an ongoing process throughout implementation and maintenance of your MTSS-B system. Community, district, and school data help to initially identify needs and gaps in services; fidelity data provide a blueprint and reflect the quality of implementation; and reach and outcome data provide feedback on the scope and impact of your efforts.

3. Make a Plan

After reviewing relevant community risk/protective factors, MTSS-B fidelity scores, and local district/school data sources, the District-Community Leadership Team articulates district-wide MTSS-B priorities and goals, with associated action plans and progress monitoring metrics. These plans guide school-level action plans and implementation, and all are revised regularly to support ongoing learning and adjustment.

MTSS-B NH overview infographic

4. Implement Strategies

Action plans guide implementation of MTSS-B strategies, including professional development and coaching; comprehensive social-emotional screening; Tier 1 and Advanced Tier (2/3) procedures; and facilitated referral pathways to community mental health. Teams use a structured, collaborative, and data-driven process to select EBPs that support student outcomes that are aligned across three tiers: Tier 1 universal supports for all; Tier 2 targeted services for at-risk students; and Tier 3 individual interventions for those with the highest need.

5. Monitor Progress

Implementation of the overarching MTSS-B framework and individual evidence-based practices are measured for (1) reach - the scope of support/service delivery; (2) fidelity – the degree to which the framework and specific interventions are delivered as the guiding model intended; and (3) student outcomes – at the whole-school (e.g., school climate, schoolwide office discipline referral rates) and individual student (e.g., social-emotional, mental health, and academic engagement) levels.

Implementation Phases

Phase 1


Assess the match between local district-community need and the MTSS-B framework’s values, core features, and strategies, including an evaluation of current systems, practices, and resources to ensure MTSS-B fit and feasibility within your school district-community context

Phase 2

District-level Implementation

A District-Community Leadership Team with representation from district/school and partnering community youth & family-serving agencies guides implementation of district-wide MTSS-B priorities, goals, structures, and systems needed to support an integrated social-emotional-behavioral and mental health service delivery model across schools

Phase 3

School-level Implementation

Install MTSS-B systems and structures at the school level, guided by district-wide goals including teaming across tiers, screening procedures, data-based decision-making protocols, implementation of evidence-based practices, ongoing coaching, performance feedback, and progress monitoring

Strategies & Routines

Establish a Tier 1 team to plan and guide implementation of universal/schoolwide routines, programming, and supports

Develop and teach positive schoolwide behavior expectations that describe how all individuals in a school can behave in alignment with school and community values

Establish a behavior acknowledgment system to recognize and reinforce students when they engage in positive behaviors

Develop a schoolwide behavior response plan that emphasizes inclusive, restorative, and problem-solving disciplinary practices

Implement a social-emotional learning curriculum that offers lesson plans and supports for delivering social and emotional knowledge and skill-development

Align health education and prevention programs with MTSS-B, including mental health literacy and suicide, violence, and substance misuse prevention programs

Monitor aggregate student and school-level outcomes data to inform decision-making and ongoing quality improvement of Tier 1 systems, programs, and supports

Establish Advanced Tier team(s) to guide implementation of screening and referral procedures and develop a comprehensive array of Tier 2/3 supports and services

Implement a universal social-emotional screening process to identify students who may require additional social-emotional or behavioral support

Develop a request for assistance process by which social-emotional and mental health support can be sought for students

Select high-leverage Tier 2/3 interventions that are evidence-based, culturally relevant, feasible to implement, and meet student needs

Develop facilitated referral pathways to community mental health to improve access to specialized services for higher-need youth and their families

Monitor fidelity, reach, and aggregate outcomes of Tier 2 and 3 interventions to inform mid-course corrections and quality improvement

Monitor student response to intervention by measuring progress on individualized goals and outcomes by an individual student support team

What is MTSS-B?

Current Landscape in NH

See where and how MTSS-B is being implemented

What is MTSS-B?

Timeline in NH

Explore NH’s MTSS-B timeline

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