Does Your District Have a MTSS Playbook for Mental Health?

By Duncan Young, CEO

As districts look to return to more normal in-person schooling, many of them are examining the strength of the mental health safety net that awaits students. An increasing volume of research points to the fact that students will likely face both an increased intensity and increased frequency of mental health challenges as schools re-open. Part of this district self-assessment involves a review of gaps in the Multi-Tiered Systems of Support (MTSS) Framework that districts have in place, including:

· Roles and responsibilities that are sometimes ill-defined.

· Lack of consistency in mental health interventions across buildings.

· Lack of clear standards for key clinical processes like documentation, clinical supervision, and risk management.

· An inconsistent “flow” of students through intervention support tiers, including students who might “jump” from one Tier to another without progressing through intermediate levels of care.

Districts are increasingly identifying the fact that they lack a unified, programmatic vision for what mental health support “looks like” in their district. In short, they are lacking an “MTSS Playbook for Mental Health.”

The Perils of “Random Acts of Therapy”

Many districts have designed their MTSS approach for mental health in a piecemeal fashion. Many districts focus on certain initiatives in isolation, e.g., one year the focus might be on adopting an SEL curriculum at the Tier 1 level, the next year the focus might be on universal mental health screening, and the next year the focus might be on Tier 3 in-school programming. Each of these initiatives is well-intentioned and might achieve some success in isolation. But separately planned initiatives are not always designed to work together and as such can cause confusion. Eight different schools might adopt eight different SELs or the definition of a “Tier 2” clinical intervention might be different from building to building. There may be confusion in the roles and responsibilities of different team members involved with mental health treatment. Sometimes there is not even agreement as to what constitutes a Tier 3 vs. a Tier 2 intervention. We call such trends “random acts of therapy”, and they are a recipe for mental health programming that produces lower than desired impact and success.

What is a MTSS Playbook and why is it important?

A MTSS for Mental Health Playbook is an antidote to the challenges of “random acts of therapy.” The playbook itself is a document that lays out how a school district will implement MTSS in the mental health domain according to best practices and with consistency. Just as important as the end document, however, is the process of creating the playbook. A playbook creation process provides a healthy environment for the important conversations around roles, responsibilities, and processes that are necessary for a district to improve its delivery of mental health care.

What should a MTSS Playbook cover?

It’s helpful to think of the MTSS Playbook as an actual “book” and to think of each focus area of the playbook as a “chapter.” While there is no “one size fits all” answer for how a playbook should be structured, the following is a sample organization:

• Chapter 1: District Mental Health Oversight Structure. Includes organizational structure, roles and responsibilities, role of general ed vs. special ed, and a description of the district’s intervention and referral services (I&RS)
• Chapter 2: Clinical Practices for Tier 3. A description of the programs and practices that govern Tier 3 services for students with moderate to severe mental health challenges, including program design, admissions and discharge criteria, exclusionary criteria, modalities of care and specialized protocols for dealing with acute issues like substance abuse, crisis response and school avoidance.
• Chapter 3: Clinical Practices for Tier 2. The same topics as in Chapter 2 but covering Tier 2 programs for students with mild to moderate challenges.
• Chapter 4: Implementation of Tier 1 Universal Supports. Identification of universal supports like any district wide SELs or programs like PBIS, standards for implementation and data collection, and a mental health professional development plan for educators.
• Chapter 5: Quality Management and Data Collection. The processes by which the quality of clinical support is being assessed, how high-risk cases are managed, and what kind of documentation is being kept.
• Chapter 6: Supervisory Oversight. Methods for providing clinical supervision support and overseeing/managing the delivery of mental health care.
• Chapter 7: Intake and Referral Processes. Use of assessment tools and screening tools.

What is the process for creating a MTSS Playbook?

The process for creating a MTSS for Mental Health Playbook is just as important as the end product. We recommend the creation of a MTSS for Mental Health Steering Committee that will lead the effort. This should be made up of a combination of central office staff, building leadership and district clinical staff, including at least one member who has a high degree of expertise in clinical-quality mental health care. Next, districts should conduct an audit of their existing programs and documentation. Out of this audit, gaps and areas for improvement will be identified. Finally, the work of creating updated processes, protocols, and tools to fill in the identified gaps begins.

In Summary….

In summary, the creation or revision of a MTSS for Mental Health Playbook is an intensive process but one that yields tremendous benefit for both a district and its students. Now is the perfect time for districts to focus on Playbook creation, as it has never been more important to strengthen our mental health infrastructure to support all students.

Perhaps, in years to come, the COVID-19 pandemic will be recognized as the tipping point that brought schools fully into their own as the preferred site for the delivery of an even more powerful set of mental health services for our most at-risk students.