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NH’s Multi-Tiered System of Support for Behavioral Health and Wellness Model (MTSS-B)

NH’s Multi-Tiered System of Support for Behavioral Health and Wellness Model is a comprehensive system of social, emotional, and behavioral supports to promote student wellness and improve engagement in learning.


Student wellness lens Districts support a whole child approach to education that recognizes the intersections between physical, social.emotional and behavioral health, and how they impact student academic attainment.

Community-driven Efforts to enhance social-emotional and mental health supports for students and their families, while incorporating essential core features of the MTSS-B model, are locally defined and driven by identified community need.

Trauma responsive Supports are infused with a consideration of adverse childhood experiences (ACE's), relationship-based teaching approaches, and attention to the needs underlying student behavior.

Youth voice Youth/student perspectives are incorporated into MTSS-B implementation. Youth have input regarding choice of supports at all tiers. Youth leaders serve as mentors for their peers.

Family engagement Schools promote two-way communication and relationship building, build on family strengths, and support caregiver decision-making and participation in their children's education.

Equity and cultural competence An equity perspective, including recognizing root causes  of disparities, is infused throughout the district's vision, goals and strategies. Interventions are responsive to families cultural context and promote accessibility for all.

Core Features

Social-emotional & mental health for all Student and school wellness is an articulated district priority. Social- emotional learning and mental health are integrated throughout school culture, including school wide curricula and classroom management, as well as interventions for students with additional needs.

Integrated delivery system 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.

Tiered prevention framework Supports are delivered across three tiers:

Tier 1: School-wide approaches

Tier 2: Targeted supports for at-risk students

Tier 3: Individualized services for highest-needs students

Focus on student outcomes MTSS-B is monitored by outcomes including (1) school-wide measures such as school climate, problem behaviors, nurse visits, attendance; and (2) individual student-level measures of social- emotional, mental health, and academic functioning.

MTSS-B Strategies

Explore the MTSS-B Toolkit at 

Team-based decision making A district-community leadership team (DCLT) with cross-sector representation, decision-making authority, and knowledge convenes to develop a shared vision for student wellness and drive installation of MTSS-B. The DCLT supports school-level trams which include school mental health, and family representation to address student social-emotional, behavioral and mental health needs in a coordinated, integrated approach across all tiers.

Use of school & community data The DCLT and school level teams rely in school data (e.g. attendance, grades, discipline, nurse visits) and community data such as substance use, domestic violence, homelessness to identify, prioritize, and monitor needs related to student wellness. These data inform the development of measurable outcomes by which MTSS-B can be monitored.

Selection of evidence-based practices across tiers Teams with representation from school and community use a structured, collaborative, and data-driven process to select evidence-based practices (EBT's) that support student outcomes which are aligned across the 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.

Early access through a comprehensive screening process The DCLT adopts a structured, comprehensive universal screening procedure to identify students in need of targeted and intensive supports, using data-driven sources that identify internalizing (e.g. withdrawal, anxiety, depression) and externalizing behaviors (e.g. conduct and other acting-out) as well as other indicators of student risk, such as office discipline referrals, attendance, academic performance, nurse visits etc.

Ongoing coaching & performance feedback Professional development and ongoing training, coaching, and performance feedback are provided to school and mental health staff at all tiers. Mental health providers receive training on Tier 1and lower level Tier 2 supports, while teachers receive coaching and technical assistance on supporting social-emotional concerns in the classroom and in recognizing mental health needs in students.

Progress monitoring for fidelity and impact EBP's are monitored for fidelity - the degree to which the intervention is delivered as the guiding model intended. Fidelity of the overarching MTSS-B is measured using NH's MTSS-B Fidelity Inventory. Student outcomes are monitored at the whole-school (e.g. school climate, school-wide ODR rates) and individual student levels (e.g. social-emotional, mental-health, and academic functioning.

Video Introduction of MTSSB