Getting “SMART” about implementing multi-tiered systems of support to promote school mental health
Open accessAbstract
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.
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The comprehensive, empirical, sustainable, and efficient nature of MTSS is designed to optimize limited resources and is thus becoming widely adopted in school settings.
“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).”
From Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 1) (2019) · cites this paper as August et al., 2018
The Abstract (page unavailable) describes MTSS as layered and empirically driven and says its implementation is proliferating in educational settings. It does not establish that MTSS is sustainable or already optimizes limited resources; instead, it calls maintaining efficiency and feasibility a challenge. The Conclusion (page unavailable) presents reduced cost as a potential benefit of adding SMART designs, not an established property of MTSS. (LLM, conf=0.86)
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- Authors
- August, G. J., Piehler, T. F., & Miller, F. G.
- Affiliations
- University of Minnesota (US)
- Corresponding author
- Piehler, Timothy F.
- Venue
- Journal of School Psychology
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 66
- Pages
- 85-96
- ISSN
- 0022-4405 (ISSN-L)
- PMC
- PMC5812372
- OpenAlex
- W2765592309
- Cited by
- 87
- References
- 75
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 14 · 2023: 12 · 2022: 15 · 2021: 7 · 2020: 7 · 2019: 6 · 2018: 2 · 2017: 2
- FWCI
- 9.41
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of School Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIMH (P20 MH085987, R34 MH097832)
- Topics
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Social Sciences › Education › Early Childhood Education and Development
- Keywords
- multi-tiered systems of support, school mental health, adaptive treatment strategies, sequential multiple assignment randomized trial, treatment sequencing, prevention, Positive Behavioral Interventions and Supports, social-emotional learning, evidence-based interventions, implementation evaluation
- MeSH terms
- Health Promotion, Humans, Mental Health, Mental Health Services, School Health Services, Schools, Students
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